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Tubeeckx MRL, De Keulenaer GW, Heidbuchel H, Segers VFM. Pathophysiology and clinical relevance of atrial myopathy. Basic Res Cardiol 2024; 119:215-242. [PMID: 38472506 DOI: 10.1007/s00395-024-01038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/14/2024]
Abstract
Atrial myopathy is a condition that consists of electrical, structural, contractile, and autonomic remodeling of the atria and is the substrate for development of atrial fibrillation, the most common arrhythmia. Pathophysiologic mechanisms driving atrial myopathy are inflammation, oxidative stress, atrial stretch, and neurohormonal signals, e.g., angiotensin-II and aldosterone. These mechanisms initiate the structural and functional remodeling of the atrial myocardium. Novel therapeutic strategies are being developed that target the pathophysiologic mechanisms of atrial myopathy. In this review, we will discuss the pathophysiology of atrial myopathy, as well as diagnostic and therapeutic strategies.
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Affiliation(s)
- Michiel R L Tubeeckx
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium.
| | - Gilles W De Keulenaer
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium
- Department of Cardiology, ZNA Middelheim Hospital Antwerp, Antwerp, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Vincent F M Segers
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
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Huang Y, Wang LL, Liu ZB, Chen C, Ren X, Luo AT, Ma JH, Antzelevitch C, Barajas-Martínez H, Hu D. Underlying mechanism of atrial fibrillation-associated Nppa-I137T mutation and cardiac effect of potential drug therapy. Heart Rhythm 2024; 21:184-196. [PMID: 37924963 DOI: 10.1016/j.hrthm.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND More than a hundred genetic loci have been associated with atrial fibrillation (AF). But the exact mechanism remains unclear and the treatment needs to be improved. OBJECTIVE This study aimed to investigate the mechanism and potential treatment of NPPA mutation-associated AF. METHODS Nppa knock-in (KI, p.I137T) rats were generated, and cardiac function was evaluated. Blood pressure was recorded using a tail-cuff system. The expression levels were measured using real-time polymerase chain reaction, enzyme-linked immunosorbent assay or Western blot analysis, and RNA-sequence analysis. Programmed electrical stimulation, patch clamp, and multielectrode array were used to record the electrophysical characteristics. RESULTS Mutant rats displayed downregulated expression of atrial natriuretic peptide but elevated blood pressure and enlarged left atrial end-diastolic diameter. Further, gene topology analysis suggested that the majority of differently expressed genes in Nppa KI rats were related to inflammation, electrical remodeling, and structural remodeling. The expression levels of C-C chemokine ligand 5 and galectin-3 involved in remodeling were higher, while there were declined levels of Nav1.5, Cav1.2, and connexin 40. AF was more easily induced in KI rats. Electrical remodeling included abbreviated action potentials, effective refractory period, increased late sodium current, and reduced calcium current, giving rise to conduction abnormalities. These electrophysiological changes could be reversed by the late sodium current blocker ranolazine and the Nav1.8 blocker A-803467. CONCLUSION Our findings suggest that structural remodeling related to inflammation and fibrosis and electrical remodeling involved in late sodium current underly the major effects of the Nppa (p.I137T) variant to induce AF, which can be attenuated by the late sodium current blocker and Nav1.8 blocker.
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Affiliation(s)
- Yan Huang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Ling-Ling Wang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Zhe-Bo Liu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Cheng Chen
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiang Ren
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - An-Tao Luo
- Cardio-Electrophysiological Research Laboratory, Medical College of Wuhan University of Science and Technology, Wuhan, Hubei, China; Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Medical College of Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Ji-Hua Ma
- Cardio-Electrophysiological Research Laboratory, Medical College of Wuhan University of Science and Technology, Wuhan, Hubei, China; Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Medical College of Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Hector Barajas-Martínez
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China.
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Wang J, Liu Y, Ma C, Zhang Y, Yuan M, Li G. Ameliorative Impact of Liraglutide on Chronic Intermittent Hypoxia-Induced Atrial Remodeling. J Immunol Res 2022; 2022:8181474. [PMID: 35465349 PMCID: PMC9020937 DOI: 10.1155/2022/8181474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/03/2022] Open
Abstract
Atrial fibrillation (AF) is the most frequent form of clinical cardiac arrhythmias. Previous evidence proved that atrial anatomical remodeling (AAR) and atrial electrical remodeling (AER) are crucial for the progression and maintenance of AF. This study is aimed at investigating the impact of the glucagon-like peptide-1 (GLP-1) receptor agonist, Liraglutide (Lir), on atrial remodeling (AR) mouse model induced by chronic intermittent hypoxia (CIH). C57BL/6 mice were categorized randomly into the control, Lir, CIH, and CIH+Lir groups. CIH was performed in CIH and CIH+Lir groups for 12 weeks. Lir (0.3 mg/kg/day, s.c) was administered to the Lir and CIH+Lir groups for four weeks, beginning from the ninth week of CIH. Meanwhile, echocardiography and right atrial endocardial electrophysiology via jugular vein, as well as induction rate and duration of AF, were evaluated. Masson and Sirius red staining assays were utilized to assess the extent of fibrosis in the atrial tissue of the mice. Immunohistochemical staining, RT-qPCR, and Western blotting were performed to evaluate the marker levels of AAR and AER and the expression of genes and proteins of the miR-21/PTEN/PI3K/AKT signaling pathway, respectively. ELISA was also performed to evaluate the changes of serum inflammatory factor levels. The CIH group exhibited significant AR, increased atrial fibrosis, and a higher incidence rate of AF compared to the control group. Lir could significantly downregulate the protein expression level in the PI3K/p-AKT pathway and upregulated that of phosphatase and tensin homolog deleted on chromosome ten (PTEN). Moreover, Lir downregulated the expression of miR-21. However, the protein expressions of CACNA1C and KCNA5 in atrial tissue were not changed significantly. In addition, Lir significantly attenuated the levels of markers of inflammation (TNF-α and IL-6) in the serum. In the mouse model of CIH, Lir treatment could ameliorate AR by the miR-21/PTEN/PI3K/AKT signaling pathway and modulation of inflammatory responses.
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Affiliation(s)
- Jun Wang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Yongzheng Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Changhui Ma
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Yue Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Meng Yuan
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
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Guo F, Li C, Yang L, Chen C, Chen Y, Ni J, Fu R, Jiao Y, Meng Y. Impact of left atrial geometric remodeling on late atrial fibrillation recurrence after catheter ablation. J Cardiovasc Med (Hagerstown) 2021; 22:909-916. [PMID: 34506349 DOI: 10.2459/jcm.0000000000001255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS To quantitatively investigate the impact of left atrial geometric remodeling on atrial fibrillation recurrence after catheter ablation. METHODS A retrospective analysis of 105 patients with atrial fibrillation who underwent coronary computed tomographic angiography before catheter ablation. Risk factors for atrial fibrillation recurrence were identified by multivariable logistic regression analysis and used to create a nomogram. RESULTS After at least 12 months of follow-up, 30 patients (29%) developed recurrent atrial fibrillation. Patients with recurrence had higher left atrial volume, left atrial sphericity, and lower left atrial ejection fraction (LAEF) (P < 0.05). There was no significant difference in asymmetry index between the two groups (P = 0.121). Multivariable regression analysis showed that left atrial minimal volume index (LAVImin) [odds ratio (OR): 1.026, 95% confidence interval (CI): 1.002-1.050, P = 0.034], left atrial sphericity (OR: 1.222, 95% CI: 1.040-1.435, P = 0.015) and CHADS2 score (OR: 1.511, 95% CI: 1.024-2.229, P = 0.038) were independent predictors of atrial fibrillation recurrence. The combined model of the left atrial sphericity to the LAVImin substantially increased the predictive power for atrial fibrillation recurrence [area under the curve (AUC) = 0.736, 95% CI: 0.627-0.844, P < 0.001], with a sensitivity of 80% and a specificity of 61%. A nomogram was generated based on the contribution weights of the risk factors; the AUC was 0.772 (95% CI: 0.670-0.875) and had good internal validity. CONCLUSION The CHADS2 score, left atrial sphericity, and LAVImin were significant and independent predictors of atrial fibrillation recurrence after catheter ablation. Furthermore, the nomogram had a better predictive capacity for atrial fibrillation recurrence.
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Affiliation(s)
- Fuqian Guo
- Department of Medical Imaging, The Second Hospital, Hebei Medical University, Shijiazhuang, Hebei, China
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Zhou J, Bai L, Zhang XJ, Li H, Cai J. Nonalcoholic Fatty Liver Disease and Cardiac Remodeling Risk: Pathophysiological Mechanisms and Clinical Implications. Hepatology 2021; 74:2839-2847. [PMID: 34309877 DOI: 10.1002/hep.32072] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Jianghua Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Basic Medical School, Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Lan Bai
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Xiao-Jing Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Jingjing Cai
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
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Liu C, Liu S, Li H, Guo YL. A Potential Novel Indication for Preventing Thromboembolism in Patients with Atrial Arrhythmias: Remodeling of the Left Atrium. Curr Med Sci 2021; 41:1187-1191. [PMID: 34705215 DOI: 10.1007/s11596-021-2449-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Thrombosis in patients with atrial arrhythmias might be associated with remodeling of the left atrium (LA). We aimed to describe this relationship and identify a novel factor, in addition to the CHA2DS2-VASc score, to guide therapeutic strategies for preventing thromboembolism in the hope of improving the prognosis for such patients. METHODS Patients diagnosed with atrial arrhythmias and who met our inclusion criteria were enrolled in this study. Various clinical parameters were recorded; diameters reflecting remodeling of the LA were measured and thrombosis was diagnosed by enhanced CT. RESULTS Totally, 192 patients were enrolled in the study. The overall prevalence of left atrial thrombosis was 8.3%. Patients with persistent atrial fibrillation exhibited the highest anteroposterior diameter of the LA (45.1±7.2 mm) and prevalence of thrombosis (15.6%). An anteroposterior LA diameter of ≥50 mm was a strong independent impact risk factor for thrombosis (OR=10.1, 95%CI: 2.8-36.9, P<0.001). The prevalence of LA thrombosis in patients with and without anteroposterior LA diameter of ≥50 mm was 25.8% and 5.0%, respectively. CONCLUSION Marked remodeling of the LA characterized by an anteroposterior LA diameter of ≥50 mm is a strong independent risk factor of thrombosis, and should be considered for the prevention of thromboembolism through various strategies.
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Affiliation(s)
- Chen Liu
- Department of Cardiology, Fuwai Yunnan Cardiovascular Hospital, Kunming, 650000, China
| | - Shuang Liu
- Department of Rheumatology, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, China
| | - Hui Li
- Department of Radiology, Fuwai Yunnan Cardiovascular Hospital, Kunming, 650000, China
| | - Yu-Long Guo
- Department of Cardiology, Fuwai Yunnan Cardiovascular Hospital, Kunming, 650000, China.
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Abstract
Around the world there are 33.5 million patients suffering from atrial fibrillation (AF) with an annual increase of 5 million cases. Most AF patients have an established form of an atrial cardiomyopathy. The concept of atrial cardiomyopathy was introduced in 2016. Thus, therapy of underlying diseases and atrial tissue changes appear as a cornerstone of AF therapy. Furthermore, therapy or prevention of atrial endocardial changes has the potential to reduce atrial thrombogenesis and thereby cerebral stroke. The present manuscript will summarize the underlying pathophysiology and remodeling processes observed in the development of an atrial cardiomyopathy, thrombogenesis, and atrial fibrillation. In particular, the impact of oxidative stress, inflammation, diabetes, and obesity will be addressed.
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Affiliation(s)
- Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz Hospital, 33098 Paderborn, Germany
- MAESTRIA Consortium/AFNET, 48149 Münster, Germany
- Correspondence:
| | - Uwe Lendeckel
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, 17475 Greifswald, Germany;
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Bai J, Lu Y, Zhu Y, Wang H, Yin D, Zhang H, Franco D, Zhao J. Understanding PITX2-Dependent Atrial Fibrillation Mechanisms through Computational Models. Int J Mol Sci 2021; 22:7681. [PMID: 34299303 PMCID: PMC8307824 DOI: 10.3390/ijms22147681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 01/11/2023] Open
Abstract
Atrial fibrillation (AF) is a common arrhythmia. Better prevention and treatment of AF are needed to reduce AF-associated morbidity and mortality. Several major mechanisms cause AF in patients, including genetic predispositions to AF development. Genome-wide association studies have identified a number of genetic variants in association with AF populations, with the strongest hits clustering on chromosome 4q25, close to the gene for the homeobox transcription PITX2. Because of the inherent complexity of the human heart, experimental and basic research is insufficient for understanding the functional impacts of PITX2 variants on AF. Linking PITX2 properties to ion channels, cells, tissues, atriums and the whole heart, computational models provide a supplementary tool for achieving a quantitative understanding of the functional role of PITX2 in remodelling atrial structure and function to predispose to AF. It is hoped that computational approaches incorporating all we know about PITX2-related structural and electrical remodelling would provide better understanding into its proarrhythmic effects leading to development of improved anti-AF therapies. In the present review, we discuss advances in atrial modelling and focus on the mechanistic links between PITX2 and AF. Challenges in applying models for improving patient health are described, as well as a summary of future perspectives.
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Affiliation(s)
- Jieyun Bai
- College of Information Science and Technology, Jinan University, Guangzhou 510632, China; (Y.L.); (Y.Z.)
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - Yaosheng Lu
- College of Information Science and Technology, Jinan University, Guangzhou 510632, China; (Y.L.); (Y.Z.)
| | - Yijie Zhu
- College of Information Science and Technology, Jinan University, Guangzhou 510632, China; (Y.L.); (Y.Z.)
| | - Huijin Wang
- College of Information Science and Technology, Jinan University, Guangzhou 510632, China; (Y.L.); (Y.Z.)
| | - Dechun Yin
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin 150000, China;
| | - Henggui Zhang
- Biological Physics Group, School of Physics & Astronomy, The University of Manchester, Manchester M13 9PL, UK;
| | - Diego Franco
- Department of Experimental Biology, University of Jaen, 23071 Jaen, Spain;
| | - Jichao Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
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Lim WW, Neo M, Thanigaimani S, Kuklik P, Ganesan AN, Lau DH, Tsoutsman T, Kalman JM, Semsarian C, Saint DA, Sanders P. Electrophysiological and Structural Remodeling of the Atria in a Mouse Model of Troponin-I Mutation Linked Hypertrophic Cardiomyopathy: Implications for Atrial Fibrillation. Int J Mol Sci 2021; 22:ijms22136941. [PMID: 34203369 PMCID: PMC8267948 DOI: 10.3390/ijms22136941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 01/26/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disorder affecting one in 500 of the general population. Atrial fibrillation (AF) is the most common arrhythmia in patients with HCM. We sought to characterize the atrial electrophysiological and structural substrate in young and aging Gly203Ser cardiac troponin-I transgenic (HCM) mice. At 30 weeks and 50 weeks of age (n = 6 per strain each group), the left atrium was excised and placed on a multi-electrode array (MEA) for electrophysiological study; subsequent histological analyses and plasma samples were analyzed for biomarkers of extracellular matrix remodeling and cell adhesion and inflammation. Wild-type mice of matched ages were included as controls. Young HCM mice demonstrated significantly shortened atrial action potential duration (APD), increased conduction heterogeneity index (CHI), increased myocyte size, and increased interstitial fibrosis without changes in effective refractory periods (ERP), conduction velocity (CV), inflammatory infiltrates, or circulating markers of extracellular matrix remodeling and inflammation. Aging HCM mice demonstrated aggravated changes in atria electrophysiology and structural remodeling as well as increased circulating matrix metalloproteinases (MMP)-2, MMP-3, and VCAM-1 levels. This model of HCM demonstrates an underlying atrial substrate that progresses with age and may in part be responsible for the greater propensity for AF in HCM.
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Affiliation(s)
- Wei-Wen Lim
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (W.-W.L.); (M.N.); (S.T.); (P.K.); (A.N.G.); (D.H.L.)
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore 169609, Singapore
- Programme in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Melissa Neo
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (W.-W.L.); (M.N.); (S.T.); (P.K.); (A.N.G.); (D.H.L.)
| | - Shivshankar Thanigaimani
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (W.-W.L.); (M.N.); (S.T.); (P.K.); (A.N.G.); (D.H.L.)
- The Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry and The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
| | - Pawel Kuklik
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (W.-W.L.); (M.N.); (S.T.); (P.K.); (A.N.G.); (D.H.L.)
- Department of Cardiology, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
| | - Anand N. Ganesan
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (W.-W.L.); (M.N.); (S.T.); (P.K.); (A.N.G.); (D.H.L.)
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Dennis H. Lau
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (W.-W.L.); (M.N.); (S.T.); (P.K.); (A.N.G.); (D.H.L.)
| | - Tatiana Tsoutsman
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute and the University of Sydney, Camperdown, NSW 2050, Australia; (T.T.); (C.S.)
| | - Jonathan M. Kalman
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, VIC 3010, Australia;
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute and the University of Sydney, Camperdown, NSW 2050, Australia; (T.T.); (C.S.)
| | - David A. Saint
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (W.-W.L.); (M.N.); (S.T.); (P.K.); (A.N.G.); (D.H.L.)
- Correspondence: (D.A.S.); (P.S.); Tel.: +618-8222-2723 (P.S.)
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (W.-W.L.); (M.N.); (S.T.); (P.K.); (A.N.G.); (D.H.L.)
- Correspondence: (D.A.S.); (P.S.); Tel.: +618-8222-2723 (P.S.)
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Nakamura K, Takagi T, Kogame N, Hashimoto H, Asami M, Toyoda Y, Enomoto Y, Hara H, Noro M, Sugi K, Moroi M, Nakamura M. The Association of Cardio-Ankle Vascular Index (CAVI) with Biatrial Remodeling in Atrial Fibrillation. J Atheroscler Thromb 2021; 28:590-603. [PMID: 32863297 PMCID: PMC8219536 DOI: 10.5551/jat.57737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/08/2020] [Indexed: 12/14/2022] Open
Abstract
AIM Arterial stiffness results in elevated left ventricular filling pressure and can promote atrial remodeling due to chronic pressure overload. However, the impact of arterial stiffness on the process of atrial remodeling in association with atrial fibrillation (AF) has not been fully evaluated. METHODS We enrolled 237 consecutive patients diagnosed with AF who had undergone ablation; data from 213 patients were analyzed. Cardio-ankle vascular index (CAVI) was used as a marker of arterial stiffness. The left atrial (LA) and right atrial (RA) volumes were determined by computed tomography imaging; atrial conduction and voltage amplitude were evaluated using a three-dimensional electromapping system used to guide the ablation procedure. RESULT In univariate analysis, CAVI significantly correlated with atrial structural and electrical remodeling (LA volume index, r=0.297, P=0.001; RA volume index, r=0.252, P=0.004; LA conduction velocity, r=0.254, P= 0.003; LA mean voltage, r=-0.343, P=0.001, RA mean voltage; r=-0.245, P=0.015). Multivariate regression analysis revealed that CAVI and plasma levels of N-terminal B-type natriuretic peptide were independent determinants of LA and RA remodeling, respectively. On the other hand, age and LA conduction velocity were independent variables with respect to CAVI. Age-adjusted CAVI was highest in long-standing persistent AF when compared with measures of persistent or paroxysmal AF. CONCLUSION CAVI was closely associated with biatrial remodeling in patients diagnosed with AF. These results suggest that arterial stiffness may play a significant role with respect to disease progression.
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Affiliation(s)
- Keijiro Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Takahito Takagi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Norihiro Kogame
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hikari Hashimoto
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Masako Asami
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasutake Toyoda
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshinari Enomoto
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hidehiko Hara
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Mahito Noro
- Cardiovascular Center, Toho University Sakura Medical Center, Chiba, Japan
| | - Kaoru Sugi
- Division of Cardiovascular Medicine, Odawara Cardiovascular Hospital, Kanagawa, Japan
| | - Masao Moroi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
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11
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Kiedrowicz RM, Wielusinski M, Wojtarowicz A, Kazmierczak J. Left and right atrial appendage functional features as predictors for voltage-defined left atrial remodelling in patients with long-standing persistent atrial fibrillation. Heart Vessels 2021; 36:853-862. [PMID: 33386923 PMCID: PMC8093174 DOI: 10.1007/s00380-020-01752-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/04/2020] [Indexed: 12/03/2022]
Abstract
It was hypothesised that left atrial (LA) fibrosis identified by the presence of low-voltage areas (LVA) may influence the mechanical and electrical function of the left (LAA) and right (RAA) atrial appendage among the long-standing persistent atrial fibrillation (LSPAF) population. 140 consecutive patients underwent voltage mapping of LA with a multielectrode catheter following pulmonary vein isolation and restoration of sinus rhythm with cardioversion. Echocardiography determined LAA peak outflow and inflow velocities and intracardiac catheter-based mean LAA and RAA AF cycle length (AFCL) were obtained during AF before ablation. The impact of flow velocities and AFCL on the prevalence and location of LVA was further evaluated. LVA were detected in 54% of the patients. 14% of the patients presented severe global LVA burden > 20% of the total LA surface area. 29% of the patients presented a disseminated pattern of remodelling as 3 out of 5 LA segments were affected. LAA AFCL, RAA AFCL, LAA flow velocities did not predict the absolute presence of LVA. However LAA AFCL > 155 ms predicted disseminated LVA pattern and LAA AFCL > 165 ms severe LVA incidence. LAA AFCL > 155 ms was predictive for existence of LVA within antero-septal LA segments whilst LAA emptying velocity ≤ 0.2 m/s within lateral wall. Moreover RAA AFCL > 165 ms was strongly related to the presence of LAA AFCL > 15 ms and > 165 ms. LAA and RAA functional assessment was predictive of the presence of advanced stages of voltage-defined LA fibrosis and its regional distribution among LSPAF population.
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Affiliation(s)
- Radoslaw Marek Kiedrowicz
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111, Szczecin, Poland.
| | - Maciej Wielusinski
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111, Szczecin, Poland
| | - Andrzej Wojtarowicz
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111, Szczecin, Poland
| | - Jaroslaw Kazmierczak
- Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111, Szczecin, Poland
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12
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Chang SH, Chan YH, Chen WJ, Chang GJ, Lee JL, Yeh YH. Tachypacing-induced CREB/CD44 signaling contributes to the suppression of L-type calcium channel expression and the development of atrial remodeling. Heart Rhythm 2021; 18:1760-1771. [PMID: 34023501 DOI: 10.1016/j.hrthm.2021.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atrial fibrillation (AF), a common arrhythmia in clinics, is characterized as downregulation of L-type calcium channel (LTCC) and shortening of atrial action potential duration (APD). Our prior studies have shown the association of CD44 with AF genesis. OBJECTIVE The purpose of this study was to explore the potential role of CD44 and its related signaling in tachypacing-induced downregulation of LTCC. METHODS AND RESULTS In vitro, tachypacing in atrium-derived myocytes (HL-1 cell line) induced activation (phosphorylation) of cyclic adenosine monophosphate response element-binding protein (CREB). Furthermore, tachypacing promoted an association between CREB and CD44 in HL-1 myocytes, which was documented in atrial tissues from patients with AF. Deletion and mutational analysis of the LTCC promoter along with chromatin immunoprecipitation revealed that cyclic adenosine monophosphate response element is essential for tachypacing-inhibited LTCC transcription. Tachypacing also hindered the binding of p-CREB to the promoter of LTCC. Blockade of CREB/CD44 signaling in HL-1 cells attenuated tachypacing-triggered downregulation of LTCC and shortening of APD. Atrial myocytes isolated from CD44-/- mice exhibited higher LTCC current and longer APD than did those from wild-type mice. Ex vivo, tachypacing caused less activation of CREB in CD44-/- mice than in wild-type mice. In vivo, burst atrial pacing stimulated less inducibility of AF in CREB inhibitor-treated mice than in controls. CONCLUSION Tachypacing-induced CREB/CD44 signaling contributes to the suppression of LTCC, which provides valuable information about the pathogenesis of atrial modeling and AF.
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Affiliation(s)
- Shang-Hung Chang
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Yi-Hsin Chan
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Wei-Jan Chen
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
| | - Gwo-Jyh Chang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao-Yuan, Taiwan
| | - Jia-Lin Lee
- Institute of Molecular and Cellular Biology and Department of Medical Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Yung-Hsin Yeh
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
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13
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Abstract
Inflammation and fibrosis have been implicated in the pathophysiology of atrial fibrillation. Atrial fibrosis causes conduction disturbances and is a central component of atrial remodeling in atrial fibrillation. Cardiac fibroblasts, the cells responsible for fibrosis formation, are activated by inflammatory mediators and growth factors associated with systemic inflammatory conditions. Thus, inflammation contributes to atrial fibrosis; the complex interplay of these maladaptive components creates a vicious cycle of atrial remodeling progression, maintaining atrial fibrillation and increasing thrombogenicity. This review provides up-to-date knowledge regarding inflammation and fibrosis in atrial fibrillation pathophysiology and their potential as therapeutic targets.
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Affiliation(s)
- Masahide Harada
- Department of Cardiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake 4701192, Japan.
| | - Stanley Nattel
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
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14
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Lemoine MD, Lemme M, Ulmer BM, Braren I, Krasemann S, Hansen A, Kirchhof P, Meyer C, Eschenhagen T, Christ T. Intermittent Optogenetic Tachypacing of Atrial Engineered Heart Tissue Induces Only Limited Electrical Remodelling. J Cardiovasc Pharmacol 2020; 77:291-299. [PMID: 33278190 DOI: 10.1097/fjc.0000000000000951] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/13/2020] [Indexed: 01/30/2023]
Abstract
ABSTRACT Atrial tachypacing is an accepted model for atrial fibrillation (AF) in large animals and in cellular models. Human induced pluripotent stem cells-derived cardiomyocytes (hiPSC-CM) provide a novel human source to model cardiovascular diseases. Here, we investigated whether optogenetic tachypacing of atrial-like hiPSC-CMs grown into engineered heart tissue (aEHT) can induce AF-remodeling. After differentiation of atrial-like cardiomyocytes from hiPSCs using retinoic acid, aEHTs were generated from ∼1 million atrial-like hiPSC-CMs per aEHT. AEHTs were transduced with lentivirus expressing channelrhodopsin-2 to enable optogenetic stimulation by blue light pulses. AEHTs underwent optical tachypacing at 5 Hz for 15 seconds twice a minute over 3 weeks and compared with transduced spontaneously beating isogenic aEHTs (1.95 ± 0.07 Hz). Force and action potential duration did not differ between spontaneously beating and tachypaced aEHTs. Action potentials in tachypaced aEHTs showed higher upstroke velocity (138 ± 15 vs. 87 ± 11 V/s, n = 15-13/3; P = 0.018), possibly corresponding to a tendency for more negative diastolic potentials (73.0 ± 1.8 vs. 68.0 ± 1.9 mV; P = 0.07). Tachypaced aEHTs exhibited a more irregular spontaneous beating pattern (beat-to-beat scatter: 0.07 ± 0.01 vs. 0.03 ± 0.004 seconds, n = 15-13/3; P = 0.008). Targeted expression analysis showed higher RNA levels of KCNJ12 [Kir2.2, inward rectifier (IK1); 69 ± 7 vs. 44 ± 4, P = 0.014] and NPPB (NT-proBNP; 39,690 ± 4834 vs. 23,671 ± 3691; P = 0.024). Intermittent tachypacing in aEHTs induces some electrical alterations found in AF and induces an arrhythmic spontaneous beating pattern, but does not affect resting force. Further studies using longer, continuous, or more aggressive stimulation may clarify the contribution of different rate patterns on the changes in aEHT mimicking the remodeling process from paroxysmal to persistent atrial fibrillation.
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Affiliation(s)
- Marc D Lemoine
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. Lemme is now with the Nanion Technologies GmbH, Ganghoferstraße, München, Germany
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Marta Lemme
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. Lemme is now with the Nanion Technologies GmbH, Ganghoferstraße, München, Germany
| | - Bärbel M Ulmer
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. Lemme is now with the Nanion Technologies GmbH, Ganghoferstraße, München, Germany
| | - Ingke Braren
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. Lemme is now with the Nanion Technologies GmbH, Ganghoferstraße, München, Germany
| | - Susanne Krasemann
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne Hansen
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. Lemme is now with the Nanion Technologies GmbH, Ganghoferstraße, München, Germany
| | - Paulus Kirchhof
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. Lemme is now with the Nanion Technologies GmbH, Ganghoferstraße, München, Germany
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; and
| | - Christian Meyer
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. Lemme is now with the Nanion Technologies GmbH, Ganghoferstraße, München, Germany
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Clinic for Cardiology, Evangelical Hospital, Düsseldorf, Germany
| | - Thomas Eschenhagen
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. Lemme is now with the Nanion Technologies GmbH, Ganghoferstraße, München, Germany
| | - Torsten Christ
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. Lemme is now with the Nanion Technologies GmbH, Ganghoferstraße, München, Germany
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15
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Walls S, Diop S, Birse R, Elmen L, Gan Z, Kalvakuri S, Pineda S, Reddy C, Taylor E, Trinh B, Vogler G, Zarndt R, McCulloch A, Lee P, Bhattacharya S, Bodmer R, Ocorr K. Prolonged Exposure to Microgravity Reduces Cardiac Contractility and Initiates Remodeling in Drosophila. Cell Rep 2020; 33:108445. [PMID: 33242407 PMCID: PMC7787258 DOI: 10.1016/j.celrep.2020.108445] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 01/08/2023] Open
Abstract
Understanding the effects of microgravity on human organs is crucial to exploration of low-earth orbit, the moon, and beyond. Drosophila can be sent to space in large numbers to examine the effects of microgravity on heart structure and function, which is fundamentally conserved from flies to humans. Flies reared in microgravity exhibit cardiac constriction with myofibrillar remodeling and diminished output. RNA sequencing (RNA-seq) in isolated hearts revealed reduced expression of sarcomeric/extracellular matrix (ECM) genes and dramatically increased proteasomal gene expression, consistent with the observed compromised, smaller hearts and suggesting abnormal proteostasis. This was examined further on a second flight in which we found dramatically elevated proteasome aggregates co-localizing with increased amyloid and polyQ deposits. Remarkably, in long-QT causing sei/hERG mutants, proteasomal gene expression at 1g, although less than the wild-type expression, was nevertheless increased in microgravity. Therefore, cardiac remodeling and proteostatic stress may be a fundamental response of heart muscle to microgravity.
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Affiliation(s)
- Stanley Walls
- Development, Aging & Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Rd., La Jolla, CA 92037, USA
| | - Soda Diop
- Development, Aging & Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Rd., La Jolla, CA 92037, USA
| | - Ryan Birse
- Development, Aging & Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Rd., La Jolla, CA 92037, USA
| | - Lisa Elmen
- Development, Aging & Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Rd., La Jolla, CA 92037, USA
| | - Zhuohui Gan
- Department of Bioengineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Sreehari Kalvakuri
- Development, Aging & Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Rd., La Jolla, CA 92037, USA
| | - Santiago Pineda
- Development, Aging & Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Rd., La Jolla, CA 92037, USA
| | - Curran Reddy
- Space Biosciences Division, NASA Ames Research Center, Mailstop 236-5, Moffett Field, CA 94035, USA
| | - Erika Taylor
- Development, Aging & Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Rd., La Jolla, CA 92037, USA
| | - Bosco Trinh
- Development, Aging & Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Rd., La Jolla, CA 92037, USA
| | - Georg Vogler
- Development, Aging & Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Rd., La Jolla, CA 92037, USA
| | - Rachel Zarndt
- Development, Aging & Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Rd., La Jolla, CA 92037, USA
| | - Andrew McCulloch
- Department of Bioengineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Peter Lee
- Department of Pathology and Laboratory Medicine, Brown University, 69 Brown Street, Providence, RI 02912, USA
| | - Sharmila Bhattacharya
- Space Biosciences Division, NASA Ames Research Center, Mailstop 236-5, Moffett Field, CA 94035, USA
| | - Rolf Bodmer
- Development, Aging & Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Rd., La Jolla, CA 92037, USA.
| | - Karen Ocorr
- Development, Aging & Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Rd., La Jolla, CA 92037, USA.
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16
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Pluteanu F, Seidl MD, Hamer S, Scholz B, Müller FU. Inward Rectifier K + Currents Contribute to the Proarrhythmic Electrical Phenotype of Atria Overexpressing Cyclic Adenosine Monophosphate Response Element Modulator Isoform CREM-IbΔC-X. J Am Heart Assoc 2020; 9:e016144. [PMID: 33191843 PMCID: PMC7763782 DOI: 10.1161/jaha.119.016144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Transgenic mice (TG) with heart-directed overexpresion of the isoform of the transcription factor cyclic adenosine monophosphate response element modulator (CREM), CREM-IbΔC-X, display spontaneous atrial fibrillation (AF) and action potential prolongation. The remodeling of the underlying ionic currents remains unknown. Here, we investigated the regulatory role of CREM-IbΔC-X on the expression of K+ channel subunits and the corresponding K+ currents in relation to AF onset in TG atrial myocytes. METHODS AND RESULTS ECG recordings documented the absence or presence of AF in 6-week-old (before AF onset) and 12-week-old TG (after AF onset) and wild-type littermate mice before atria removal to perform patch clamp, contractility, and biochemical experiments. In TG atrial myocytes, we found reduced repolarization reserve K+ currents attributed to a decrease of transiently outward current and inward rectifier K+ current with phenotype progression, and of acetylcholine-activated K+ current, age independent. The molecular determinants of these changes were lower mRNA levels of Kcnd2/3, Kcnip2, Kcnj2/4, and Kcnj3/5 and decreased protein levels of K+ channel interacting protein 2 (KChIP2 ), Kir2.1/3, and Kir3.1/4, respectively. After AF onset, inward rectifier K+ current contributed less to action potential repolarization, in line with the absence of outward current component, whereas the acetylcholine-induced action potential shortening before AF onset (6-week-old TG mice) was smaller than in wild-type and 12-week-old TG mice. Atrial force of contraction measured under combined vagal-sympathetic stimulation revealed increased sensitivity to isoprenaline irrespective of AF onset in TG. Moreover, we identified Kcnd2, Kcnd3, Kcnj3, and Kcnh2 as novel CREM-target genes. CONCLUSIONS Our study links the activation of cyclic adenosine monophosphate response element-mediated transcription to the proarrhythmogenic electrical remodeling of atrial inward rectifier K+ currents with a role in action potential duration, resting membrane stability, and vagal control of the electrical activity.
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Affiliation(s)
| | - Matthias D. Seidl
- Institute of Pharmacology and ToxicologyUniversity of MünsterMünsterGermany
| | - Sabine Hamer
- Institute of Pharmacology and ToxicologyUniversity of MünsterMünsterGermany
| | - Beatrix Scholz
- Institute of Pharmacology and ToxicologyUniversity of MünsterMünsterGermany
| | - Frank U. Müller
- Institute of Pharmacology and ToxicologyUniversity of MünsterMünsterGermany
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17
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Ghannam M, Yun HJ, Ficaro EP, Ghanbari H, Lazarus JJ, Konerman M, Shah RV, Weinberg R, Corbett JR, Oral H, Murthy VL. Multiparametric assessment of left atrial remodeling using 18F-FDG PET/CT cardiac imaging: A pilot study. J Nucl Cardiol 2020; 27:1547-1562. [PMID: 30191438 PMCID: PMC6411463 DOI: 10.1007/s12350-018-1429-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 08/08/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Left atrial (LA) remodeling is associated with structural, electric, and metabolic LA changes. Integrated evaluation of these features in vivo is lacking. METHODS Patients undergoing 18F-fluorodeoxyglucose (FDG) PET-CT during a hyperinsulinemic-euglycemic clamp were classified into sinus rhythm (SR), paroxysmal AF (PAF), and persistent AF (PerAF). The LA was semiautomatically segmented, and global FDG uptake was quantified using standardized uptake values (SUVmax and SUVmean) in gated, attenuation-corrected images and normalized to LA blood pool activity. Regression was used to relate FDG data to AF burden and critical patient factors. Continuous variables were compared using t-tests or Mann-Whitney tests. RESULTS 117 patients were included (76% men, age 66.4 ± 11.0, ejection fraction (EF) 25[22-35]%) including those with SR (n = 48), PAF (n = 55), and PerAF (n = 14). Patients with any AF had increased SUVmean (2.3[1.5-2.4] vs 2.0[1.5-2.5], P = 0.006), SUVmax (4.4[2.8-6.7] vs 3.2[2.3-4.3], P < 0.001), uptake coefficient of variation (CoV) 0.28[0.22-0.40] vs 0.25[0.2-0.33], P < 0.001), and hypometabolic scar (32%[14%-53%] vs 16.5%[0%-38.5%], P = 0.01). AF burden correlated with increased SUVmean, SUVmax, CoV, and scar independent of age, gender, EF, or LA size (P < 0.03 for all). CONCLUSIONS LA structure and metabolism can be assessed using FDG PET/CT. Greater AF burden correlates with the increased LA metabolism and scar.
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Affiliation(s)
- Michael Ghannam
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Hong Jun Yun
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Hamid Ghanbari
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - John J Lazarus
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Matthew Konerman
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Ravi V Shah
- Department of Medicine (Division of Cardiovascular Medicine), Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Weinberg
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - James R Corbett
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
- INVIA Medical Imaging Solutions, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Hakan Oral
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Venkatesh L Murthy
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA.
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
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18
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Vaze A, Tran KV, Tanriverdi K, Sardana M, Lessard D, Donahue JK, Barton B, Aurigemma G, Lubitz SA, Lin H, Nasr GH, Mandapati A, Benjamin EJ, Vasan RS, Freedman JE, McManus DD. Relations between plasma microRNAs, echocardiographic markers of atrial remodeling, and atrial fibrillation: Data from the Framingham Offspring study. PLoS One 2020; 15:e0236960. [PMID: 32813736 PMCID: PMC7437902 DOI: 10.1371/journal.pone.0236960] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/16/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Circulating microRNAs may reflect or influence pathological cardiac remodeling and contribute to atrial fibrillation (AF). OBJECTIVE The purpose of this study was to identify candidate plasma microRNAs that are associated with echocardiographic phenotypes of atrial remodeling, and incident and prevalent AF in a community-based cohort. METHODS We analyzed left atrial function index (LAFI) of 1788 Framingham Offspring 8 participants. We quantified expression of 339 plasma microRNAs. We examined associations between microRNA levels with LAFI and prevalent and incident AF. We constructed pathway analysis of microRNAs' predicted gene targets to identify molecular processes involved in adverse atrial remodeling in AF. RESULTS The mean age of the participants was 66 ± 9 years, and 54% were women. Five percent of participants had prevalent AF at the initial examination and 9% (n = 157) developed AF over a median 8.6 years of follow-up (IQR 8.1-9.2 years). Plasma microRNAs were associated with LAFI (N = 73, p<0.0001). Six of these plasma microRNAs were significantly associated with incident AF, including 4 also associated with prevalent AF (microRNAs 106b, 26a-5p, 484, 20a-5p). These microRNAs are predicted to regulate genes involved in cardiac hypertrophy, inflammation, and myocardial fibrosis. CONCLUSIONS Circulating microRNAs 106b, 26a-5p, 484, 20a-5p are associated with atrial remodeling and AF.
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Affiliation(s)
- Aditya Vaze
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Khanh-Van Tran
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Kahraman Tanriverdi
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Mayank Sardana
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Darleen Lessard
- Division of Epidemiology of Chronic Diseases, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - J. Kevin Donahue
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Bruce Barton
- Biostatistics and Health Services Research, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Gerard Aurigemma
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Steven A. Lubitz
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Honghuang Lin
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts; Computational Biomedicine Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - George H. Nasr
- Department of Medicine, University of California Irvine, Orange, California, United States of America
| | - Amiya Mandapati
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Emelia J. Benjamin
- Department of Medicine, and Department of Epidemiology, Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, United States of America
| | - Ramachandran S. Vasan
- Department of Medicine, and Department of Epidemiology, Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, United States of America
| | - Jane E. Freedman
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - David D. McManus
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
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Linssen PBC, Brunner-La Rocca HP, Schalkwijk CG, Beulens JWJ, Elders PJM, van der Heijden AA, Slieker RC, Stehouwer CDA, Henry RMA. Serum Matrix Metalloproteinases and Left Atrial Remodeling-The Hoorn Study. Int J Mol Sci 2020; 21:ijms21144944. [PMID: 32668720 PMCID: PMC7404388 DOI: 10.3390/ijms21144944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 01/11/2023] Open
Abstract
Extracellular matrix protein turnover may play an important role in left atrial (LA) remodelling. The aim is to investigate the associations between matrix metalloproteinase (MMPs), tissue inhibitor of metalloproteinase (TIMP-1) and LA volume index (LAVI) and if these associations are independent of TIMP-1 levels. Participants from The Hoorn Study, a population-based cohort study (n = 674), underwent echocardiography. Serum MMPs (i.e., MMP-1, MMP-2, MMP-3, MMP-9, and MMP-10) and TIMP-1 levels were measured with ELISA. Multiple linear regression analyses were used. MMP-1 levels were not associated with LAVI. Higher MMP-2 levels were associated with larger LAVI (regression coefficient per SD increase in MMP (95% CI); 0.03 (0.01; 0.05). Higher MMP-3 and MMP-9 levels were associated with smaller LAVI; −0.04 (−0.07; −0.01) and −0.04 (−0.06; −0.02) respectively. Only in women were higher MMP-10 levels associated with larger LAVI; 0.04 (0.00; 0.07, p-interaction 0.04). Additionally, only in women were higher TIMP-1 levels associated with smaller LAVI; −0.05 (−0.09; −0.01, p-interaction 0.03). The associations between MMPs and LAVI were independent of TIMP-1 levels. In conclusion, serum MMPs are associated with LAVI, independent of CVD risk factors and TIMP-1 levels. In addition, these associations differ according to sex and within MMP subgroups. This shows that the role of MMPs in LA remodelling is complex.
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Affiliation(s)
- Pauline B. C. Linssen
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (P.B.C.L.); (H.-P.B.-L.R.); (C.G.S.); (C.D.A.S.)
- Department of Internal Medicine, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Hans-Peter Brunner-La Rocca
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (P.B.C.L.); (H.-P.B.-L.R.); (C.G.S.); (C.D.A.S.)
- Heart and Vascular Centre, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Casper G. Schalkwijk
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (P.B.C.L.); (H.-P.B.-L.R.); (C.G.S.); (C.D.A.S.)
- Department of Internal Medicine, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Joline W. J. Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, 1007 MB Amsterdam, The Netherlands; (J.W.J.B.); (R.C.S.)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Petra J. M. Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, 1007 MB Amsterdam, The Netherlands; (P.J.M.E.); (A.A.v.d.H.)
| | - Amber A. van der Heijden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, 1007 MB Amsterdam, The Netherlands; (P.J.M.E.); (A.A.v.d.H.)
| | - Roderick C. Slieker
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, 1007 MB Amsterdam, The Netherlands; (J.W.J.B.); (R.C.S.)
- Department of Cell and Chemical Biology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Coen D. A. Stehouwer
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (P.B.C.L.); (H.-P.B.-L.R.); (C.G.S.); (C.D.A.S.)
- Department of Internal Medicine, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Ronald M. A. Henry
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (P.B.C.L.); (H.-P.B.-L.R.); (C.G.S.); (C.D.A.S.)
- Department of Internal Medicine, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
- Correspondence:
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Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia, currently affecting over 33 million individuals worldwide, and its prevalence is expected to more than double over the next 40 years. AF is associated with a twofold increase in premature mortality, and important major adverse cardiovascular events such as heart failure, severe stroke and myocardial infarction. Significant effort has been made over a number of years to define the underlying cellular, molecular and electrophysiological changes that predispose to the induction and maintenance of AF in patients. Progress has been limited by the realisation that AF is a complex arrhythmia that can be the end result of various different pathophysiological processes, with significant heterogeneity between individual patients (and between species). In this focused Review article, we aim to succinctly summarise for the non-specialist the current state of knowledge regarding the mechanisms of AF. We address all aspects of pathophysiology, including the basic electrophysiological and structural changes within the left atrium, the genetics of AF and the links to comorbidities and wider systemic and metabolic perturbations that may be upstream contributors to development of AF. Finally, we outline the translational implications for current and future rhythm control strategies in patients with AF.
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Affiliation(s)
| | - Barbara Casadei
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
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Rodríguez C, Martínez-González J. The Role of Lysyl Oxidase Enzymes in Cardiac Function and Remodeling. Cells 2019; 8:cells8121483. [PMID: 31766500 PMCID: PMC6953057 DOI: 10.3390/cells8121483] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/11/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023] Open
Abstract
Lysyl oxidase (LOX) proteins comprise a family of five copper-dependent enzymes (LOX and four LOX-like isoenzymes (LOXL1-4)) critical for extracellular matrix (ECM) homeostasis and remodeling. The primary role of LOX enzymes is to oxidize lysyl and hydroxylysyl residues from collagen and elastin chains into highly reactive aldehydes, which spontaneously react with surrounding amino groups and other aldehydes to form inter- and intra-catenary covalent cross-linkages. Therefore, they are essential for the synthesis of a mature ECM and assure matrix integrity. ECM modulates cellular phenotype and function, and strikingly influences the mechanical properties of tissues. This explains the critical role of these enzymes in tissue homeostasis, and in tissue repair and remodeling. Cardiac ECM is mainly composed of fibrillar collagens which form a complex network that provides structural and biochemical support to cardiac cells and regulates cell signaling pathways. It is now becoming apparent that cardiac performance is affected by the structure and composition of the ECM and that any disturbance of the ECM contributes to cardiac disease progression. This review article compiles the major findings on the contribution of the LOX family to the development and progression of myocardial disorders.
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Affiliation(s)
- Cristina Rodríguez
- Institut de Recerca Hospital de la Santa Creu i Sant Pau-Programa ICCC, 08025 Barcelona, Spain
- Instituto de Investigación Biomédica Sant Pau (IIB-Sant Pau), 08041 Barcelona, Spain
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (C.R.); (J.M.-G.); Tel.: +34-93-556-5897 (C.R.); +34-93-556-5896 (J.M.-G.)
| | - José Martínez-González
- Instituto de Investigación Biomédica Sant Pau (IIB-Sant Pau), 08041 Barcelona, Spain
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigaciones Biomédicas de Barcelona (IIBB-CSIC), 08036 Barcelona, Spain
- Correspondence: (C.R.); (J.M.-G.); Tel.: +34-93-556-5897 (C.R.); +34-93-556-5896 (J.M.-G.)
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Ye T, Liu X, Qu C, Zhang C, Fo Y, Guo Y, Chen X, Shi S, Yang B. Chronic inhibition of the sigma-1 receptor exacerbates atrial fibrillation susceptibility in rats by promoting atrial remodeling. Life Sci 2019; 235:116837. [PMID: 31493481 DOI: 10.1016/j.lfs.2019.116837] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022]
Abstract
AIMS This study aimed to evaluate the effects of the sigma-1 receptor (S1R) on atrial fibrillation (AF) susceptibility in rats. MAIN METHODS Rats were randomly assigned into three groups for intraperitoneal treatment with saline (CTL group), BD1047 (an antagonist of the S1R, BD group) or BD1047 plus fluvoxamine (an agonist of the S1R, BD + F group) for 4 weeks. The heart rate variability (HRV) and atrial electrophysiological parameters were measured via the PowerLab system and analyzed by LabChart 8.0 software. Atrial histology was determined with Masson staining. The protein levels of connexin (Cx) 40, Cav1.2, S1R, eNOS, p-eNOS, and p-AKT were detected by western blot assays. KEY FINDINGS Our results showed that BD1047 significantly shortened the atrial effective refractory period (ERP) and action potential duration (APD), increased AF inducibility and duration, augmented sympathetic activity, depressed parasympathetic activity, and reduced heart rate variability (HRV) compared with the CTL group. Masson staining also showed a significant increase in atrial fibrosis in the BD group. Furthermore, the expressions of S1R, Cx40, Cav1.2, p-eNOS, and p-AKT were dramatically reduced in the BD group compared with the CTL group (all P < 0.01). However, fluvoxamine administration mitigated most of the abovementioned alterations. SIGNIFICANCE Our findings indicated that S1R inhibition contributed to atrial electrical remodeling, cardiac autonomic remodeling and atrial fibrosis, which could be attenuated by fluvoxamine, thus providing new insights into the relationship between the S1R and AF.
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Affiliation(s)
- Tianxin Ye
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Xin Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Chuan Qu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Cui Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Yuhong Fo
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Yan Guo
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Xiuhuan Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Shaobo Shi
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China.
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Rao LY, Mao Y, Huang K, Li YS, Shu YW. Relationship between Atrial Tissue Remodeling and ECG Features in Atrial Fibrillation. Curr Med Sci 2019; 39:541-545. [PMID: 31346988 DOI: 10.1007/s11596-019-2071-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 06/01/2019] [Indexed: 11/26/2022]
Abstract
The difference in the atrial organizational structure between patients with atrial fibrillation (AF) and those with sinus rhythm was investigated. In order to analyze the rationality in explaining the electrocardiogram (ECG) characteristics of AF with statistics data or tissue remodeling model, and the logical relationship between the hypothesis of pulmonary veins (PV) muscle sleeves and that of multi wavelets in mechanism of AF, we examined the expression of collagen volume fraction of type I (CVF-I) with picrosirius red staining, connexin 40 (Cx40) by immunohistochemistry, and intercalated disc (ID) using transmission electron microscope in atrial tissue. The results showed that there was significant difference in the expression of CVF-I (t=3.827, P<0.01), Cx40 (t=4.21, P<0.01), and groups of the ID that keeping the electrical transmission and atrial electrical coupling synchronization (t=15.116, P<0.001), but no significant difference was found in total IDs (t=0.611, P=0.543) between patients with AF and those with sinus rhythm. The quantitative differences in the tissue remodeling could not explain the ECG characteristics of AF. The number of normal IDs and abnormal distribution are the structural basis to trigger and maintain atrial electrical remodeling, and induce and maintain AF. Such histological reconstruction supports the hypothesis of multi wavelets and can also explain ECG features.
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Affiliation(s)
- Li-Ya Rao
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yi Mao
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Kun Huang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yu-Shu Li
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yan-Wen Shu
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Fernandez-Ruocco J, Gallego M, Rodriguez-de-Yurre A, Zayas-Arrabal J, Echeazarra L, Alquiza A, Fernández-López V, Rodriguez-Robledo JM, Brito O, Schleier Y, Sepulveda M, Oshiyama NF, Vila-Petroff M, Bassani RA, Medei EH, Casis O. High Thyrotropin Is Critical for Cardiac Electrical Remodeling and Arrhythmia Vulnerability in Hypothyroidism. Thyroid 2019; 29:934-945. [PMID: 31084419 PMCID: PMC6648210 DOI: 10.1089/thy.2018.0709] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Hypothyroidism, the most common endocrine disease, induces cardiac electrical remodeling that creates a substrate for ventricular arrhythmias. Recent studies report that high thyrotropin (TSH) levels are related to cardiac electrical abnormalities and increased mortality rates. The aim of the present work was to investigate the direct effects of TSH on the heart and its possible causative role in the increased incidence of arrhythmia in hypothyroidism. Methods: A new rat model of central hypothyroidism (low TSH levels) was created and characterized together with the classical propylthiouracil-induced primary hypothyroidism model (high TSH levels). Electrocardiograms were recorded in vivo, and ionic currents were recorded from isolated ventricular myocytes in vitro by the patch-clamp technique. Protein and mRNA were measured by Western blot and quantitative reverse transcription polymerase chain reaction in rat and human cardiac myocytes. Adult human action potentials were simulated in silico to incorporate the experimentally observed changes. Results: Both primary and central hypothyroidism models increased the L-type Ca2+ current (ICa-L) and decreased the ultra-rapid delayed rectifier K+ current (IKur) densities. However, only primary but not central hypothyroidism showed electrocardiographic repolarization abnormalities and increased ventricular arrhythmia incidence during caffeine/dobutamine challenge. These changes were paralleled by a decrease in the density of the transient outward K+ current (Ito) in cardiomyocytes from animals with primary but not central hypothyroidism. In vitro treatment with TSH for 24 hours enhanced isoproterenol-induced spontaneous activity in control ventricular cells and diminished Ito density in cardiomyocytes from control and central but not primary hypothyroidism animals. In human myocytes, TSH decreased the expression of KCND3 and KCNQ1, Ito, and the delayed rectifier K+ current (IKs) encoding proteins in a protein kinase A-dependent way. Transposing the changes produced by hypothyroidism and TSH to a computer model of human ventricular action potential resulted in enhanced occurrence of early afterdepolarizations and arrhythmia mostly in primary hypothyroidism, especially under β-adrenergic stimulation. Conclusions: The results suggest that suppression of repolarizing K+ currents by TSH underlies most of the electrical remodeling observed in hypothyroidism. This work demonstrates that the activation of the TSH-receptor/protein kinase A pathway in the heart is responsible for the cardiac electrical remodeling and arrhythmia generation seen in hypothyroidism.
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Affiliation(s)
- Julieta Fernandez-Ruocco
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janerio, Brazil
- Centro de Investigaciones Cardiovasculares, Conicet La Plata, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Monica Gallego
- Departamento de Fisiología, Facultad de Farmacia, Universidad del País Vasco UPV/EHU, Vitoria, Spain
| | - Ainhoa Rodriguez-de-Yurre
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janerio, Brazil
- Departamento de Fisiología, Facultad de Farmacia, Universidad del País Vasco UPV/EHU, Vitoria, Spain
| | - Julian Zayas-Arrabal
- Departamento de Fisiología, Facultad de Farmacia, Universidad del País Vasco UPV/EHU, Vitoria, Spain
| | - Leyre Echeazarra
- Departamento de Fisiología, Facultad de Farmacia, Universidad del País Vasco UPV/EHU, Vitoria, Spain
| | - Amaia Alquiza
- Departamento de Fisiología, Facultad de Farmacia, Universidad del País Vasco UPV/EHU, Vitoria, Spain
| | - Victor Fernández-López
- Departamento de Fisiología, Facultad de Farmacia, Universidad del País Vasco UPV/EHU, Vitoria, Spain
| | - Juan M. Rodriguez-Robledo
- Departamento de Fisiología, Facultad de Farmacia, Universidad del País Vasco UPV/EHU, Vitoria, Spain
| | - Oscar Brito
- National Institute of Cardiology (INC), Rio de Janeiro, Brazil
| | - Ygor Schleier
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janerio, Brazil
| | - Marisa Sepulveda
- Centro de Investigaciones Cardiovasculares, Conicet La Plata, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | | | - Martin Vila-Petroff
- Centro de Investigaciones Cardiovasculares, Conicet La Plata, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Rosana A. Bassani
- Center for Biomedical Engineering, University of Campinas, Campinas, Brazil
| | - Emiliano H. Medei
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janerio, Brazil
| | - Oscar Casis
- Departamento de Fisiología, Facultad de Farmacia, Universidad del País Vasco UPV/EHU, Vitoria, Spain
- Address correspondence to: Oscar Casis, MD, PhD, Departamento de Fisiología, Facultad de Farmacia, Universidad del País Vasco, Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain
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Holzwirth E, Kornej J, Erbs S, Obradovic D, Bollmann A, Hindricks G, Thiele H, Büttner P. Myeloperoxidase in atrial fibrillation: association with progression, origin and influence of renin-angiotensin system antagonists. Clin Res Cardiol 2019; 109:324-330. [PMID: 31236695 DOI: 10.1007/s00392-019-01512-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/17/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myeloperoxidase (MPO), secreted by neutrophils under inflammatory conditions, is elevated in atrial fibrillation (AF). MPO may be involved in atrial remodeling that underpins AF progression characterized by a switch from paroxysmal to persistent AF and the formation of low-voltage areas (LVA). MPO levels are modulated by renin-angiotensin system antagonists (RAS-A), commonly used to treat AF comorbidities, and are associated with reduced AF incidence, implicating a potential link. OBJECTIVE We investigated MPO levels in progressing AF in peripheral and left atrial (LA) blood and analyzed a potential effect of RAS-A. METHODS Samples of AF patients were collected from the femoral vein and the LA during catheter ablation (n = 121) and at follow-up (n = 23). No-AF probands (n = 37) served as controls. MPO was determined using commercial ELISA. RESULTS MPO levels were significantly increased in AF patients compared to controls (median, 27.7 ng/ml (IQR 14.3-66.6) versus 12.6 (IQR 9.9-17.7), p < 0.001), without differences between clinical AF progression phenotypes. MPO concentration was tenfold higher in LA than periphery (279.2 ng/ml (IQR 202.2-342.9) versus 27.7 ng/ml (IQR 14.3-65.9), p < 0.001). MPO remained increased at midterm follow-up irrespective of rhythm outcome. RAS-A was associated with significantly lower peripheral (22.2 ng/ml (IQR 12.7-48.2) versus 37.1 ng/ml (IQR 18.2-85.2), p < 0.05) MPO levels in AF patients. CONCLUSION The pro-fibrotic enzyme MPO is generally elevated in AF patients irrespective of AF type, the presence of LVA or midterm rhythm outcome. Our data suggest that MPO may directly originate from the LA. RAS-A decrease peripheral MPO levels in AF patients.
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Affiliation(s)
- Erik Holzwirth
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - Jelena Kornej
- Department of Electrophysiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - Sandra Erbs
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - Danilo Obradovic
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - Petra Büttner
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
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Zapolski T, Furmaga J, Wysokiński AP, Wysocka A, Rudzki S, Jaroszyński A. The atrial uremic cardiomyopathy regression in patients after kidney transplantation - the prospective echocardiographic study. BMC Nephrol 2019; 20:152. [PMID: 31046698 PMCID: PMC6498637 DOI: 10.1186/s12882-019-1333-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/12/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In patients with end stage renal disease (ESRD), left ventricular (LV) hypertrophy with impaired LV function, which is called uremic cardiomyopathy (UC) is often observed. The UC historically has been considered a contraindication for kidney transplantation (KTx). Currently, moderate LV dysfunction does not exclude the possibility of KTx. The amelioration of uremia after KTx improved cardiac function in patients with LV dysfunction. There is a little information on the function of the left atrium (LA) after the KTx procedure. There are no studies evaluating (LA) changes in patients with UC after KTx and determining the possibility of inhibiting the occurrence of LA unfavourable changes (remodelling) and even a possible LA recovery process (reverse remodelling) as a result of a successful KTx. The aim of the study was to assess the LA reverse remodelling in patients with ESRD undergoing KTx. METHODS The study group consisted of 42 patients, aged 43.3 ± 12.6 followed for 36 months after a deceased donor KTx. The patients were studied at five time points: 1, 3, 6, 12 and 36 months after KTx. In all patients transthoracic echocardiography was performed in order to assess the following LA planimetric parameters: LAmax, LAmin, LAwaveP. LAshortmax, LAshortmin, LAshortwaveP, LAlongmax, LAlongmin, LAlongwaveP, LAcircmax and LAareamax, volumentric parameters: LA volume (LAV), LA volume index (LAVI), and hemodynamic indices: LA ejection fraction (LAEF), LA active emptying fraction (LAAE), LA passive emptying fraction (LAPE), LA index of expansion (LAIE) and LA fractional shortening (LAFS). RESULTS The LAVI values were 34.63 ± 10.34 ml/m2, 32.24 ± 9.59 ml/m2 (p < 0,001), 31.36 ± 9.20 ml/m2 (p < 0,001), 28.29 ± 8.32 ml/m2 (p < 0,001) and 27.57 ± 8.40 ml/m2 (p < 0,001), after: 1, 3, 6, 12 and 36 months after KTx, respectively. The reduction of the LA size was accompanied by gradual LA contractility improvement, which was manifested as an increase of the LA hemodynamic indices such as LAEF, LAAE, LAIE, LAFS and a decrease of LAPE. CONCLUSIONS LA remodelling secondary to atrial uraemic cardiomyopathy is an example of complex cardiomyopathy with elements characteristic of both congestive and infiltrative cardiomyopathy. Early LAVI reduction post KTx mostly depends on changed haemodynamic conditions, whereas the main reason for further decrease of LAVI values is related to resolution of uraemic toxaemia.
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Affiliation(s)
- Tomasz Zapolski
- Chair and Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Jacek Furmaga
- Department of General and Transplant Surgery and Nutritional Treatment, Medical University of Lublin, Lublin, Poland
| | | | - Anna Wysocka
- Chair and Department of Cardiology, Medical University of Lublin, Lublin, Poland
- Internal Medicine in Nursing Department, Medical University of Lublin, Lublin, Poland
| | - Sławomir Rudzki
- Department of General and Transplant Surgery and Nutritional Treatment, Medical University of Lublin, Lublin, Poland
| | - Andrzej Jaroszyński
- Department of Nephrology, Jan Kochanowski University in Kielce, Kielce, Poland
- Department of Family Medicine and Geriatrics, Jan Kochanowski University in Kielce, Kielce, Poland
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Chen R, Wen C, Fu R, Li J, Wu J. The effect of complex intramural microstructure caused by structural remodeling on the stability of atrial fibrillation: Insights from a three-dimensional multi-layer modeling study. PLoS One 2018; 13:e0208029. [PMID: 30485346 PMCID: PMC6261624 DOI: 10.1371/journal.pone.0208029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 11/10/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recent researches have suggested that the complex three-dimensional structures caused by structural remodeling play a key role in atrial fibrillation (AF) substrates. Here we aimed to investigate this hypothesis using a multi-layer model representing intramural microstructural features. METHODS The proposed multi-layer model was composed of the endocardium, connection wall, and epicardium. In the connection wall, intramural fibrosis was simulated using fibrotic patches randomly scattered in the myocardial tissue of fibrotic layers, while endo-epicardial dissociation was simulated using myocardial patches randomly scattered in the fibrotic tissue of isolation layers. Multiple simulation groups were generated to quantitatively analyze the effects of endo-epicardial dissociation and intramural fibrosis on AF stability, including a stochastic group, interrelated groups, fibrosis-degree-controlled groups, and dissociation-degree-controlled groups. RESULTS 1. Stable intramural re-entries were observed to move along complete re-entrant circuits inside the transmural wall in four of 65 simulations in the stochastic group. 2. About 21 of 23 stable simulations in the stochastic group were distributed in the areas with high endo-epicardial dissociation and intramural fibrosis. 3. The difference between fibrosis-degree-controlled groups and dissociation-degree-controlled groups suggested that some distributions of connection areas may affect AF episodes despite low intramural fibrosis and endo-epicardial dissociation. 4. The overview of tracking phase singularities revealed that endo-epicardial dissociation played a visible role in AF substrates. CONCLUSION The complex intramural microstructure is positively correlated with critical components of AF maintenance mechanisms. The occurrence of intramural re-entry further indicates the complexity of AF wave-dynamics.
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Affiliation(s)
- Riqing Chen
- Institute of Biomedical Engineering, Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Cheng Wen
- Institute of Biomedical Engineering, Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Rao Fu
- Institute of Biomedical Engineering, Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Jianning Li
- Institute of Biomedical Engineering, Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Jian Wu
- Institute of Biomedical Engineering, Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
- * E-mail:
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Kornej J, Büttner P, Hammer E, Engelmann B, Dinov B, Sommer P, Husser D, Hindricks G, Völker U, Bollmann A. Circulating proteomic patterns in AF related left atrial remodeling indicate involvement of coagulation and complement cascade. PLoS One 2018; 13:e0198461. [PMID: 30496173 PMCID: PMC6264811 DOI: 10.1371/journal.pone.0198461] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/12/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Left atrial (LA) electro-anatomical remodeling and diameter increase in atrial fibrillation (AF) indicates disease progression and is associated with poor therapeutic success. Furthermore, AF leads to a hypercoagulable state, which in turn promotes the development of a substrate for AF and disease progression in the experimental setting. The aim of this study was to identify pathways associated with LA remodeling in AF patients using untargeted proteomics approach. METHODS Peripheral blood samples of 48 patients (62±10 years, 63% males, 59% persistent AF) undergoing AF catheter ablation were collected before ablation. 23 patients with left atrial low voltage areas (LVA), defined as <0.5 mV, and 25 patients without LVA were matched for age, gender and CHA2DS2-VASc score. Untargeted proteome analysis was performed using LC-ESI-Tandem mass spectrometry in a label free intensity based workflow. Significantly different abundant proteins were identified and used for pathway analysis and protein-protein interaction analysis. RESULTS Analysis covered 280 non-redundant circulating plasma proteins. The presence of LVA correlated with 30 differentially abundant proteins of coagulation and complement cascade (q<0.05). CONCLUSIONS This pilot proteomic study identified plasma protein candidates associated with electro-anatomical remodeling in AF and pointed towards an imbalance in coagulation and complement pathway, tissue remodeling and inflammation.
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Affiliation(s)
- Jelena Kornej
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Petra Büttner
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Elke Hammer
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Beatrice Engelmann
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Daniela Husser
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Uwe Völker
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
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Kerkhof DL, Lucas C, Corrado GD. Monitoring Morphologic Changes in Male Rowers Using Limited Portable Echocardiography Performed by a Frontline Physician. J Ultrasound Med 2018; 37:2451-2455. [PMID: 29575042 DOI: 10.1002/jum.14596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/13/2018] [Accepted: 01/17/2018] [Indexed: 06/08/2023]
Abstract
Athletes' hearts have been studied for adaptive changes in response to exercise. Physiologic changes are normal responses to intense athletic training regimens, whereas pathologic changes predispose athletes to sudden cardiac death. The two alterations overlap in clinical presentation. Research continues to investigate the upper limits of cardiac remodeling to aid clinical decision making. Studying normal changes that occur in response to exercise will advance physicians' understanding of physiologic responses to exercise and potentially improve clinical distinction. To expand this body of knowledge, we present an observational case series that describes morphologic changes in athlete's hearts concurrent with performance measurements.
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Affiliation(s)
| | | | - Gianmichel D Corrado
- Northeastern University, Boston, Massachusetts, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
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30
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Vasconcellos HD, Moreira HT, Ciuffo L, Nwabuo CC, Yared GS, Ambale-Venkatesh B, Armstrong AC, Kishi S, Reis JP, Liu K, Lloyd-Jones DM, Colangelo LA, Schreiner PJ, Sidney S, Gidding SS, Lima JAC. Cumulative blood pressure from early adulthood to middle age is associated with left atrial remodelling and subclinical dysfunction assessed by three-dimensional echocardiography: a prospective post hoc analysis from the coronary artery risk development in young adults study. Eur Heart J Cardiovasc Imaging 2018; 19:977-984. [PMID: 29982431 PMCID: PMC6102802 DOI: 10.1093/ehjci/jey086] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/23/2018] [Accepted: 06/11/2018] [Indexed: 11/19/2022] Open
Abstract
Aims To evaluate the association of cumulative blood pressure (BP) from young adulthood to middle age with left atrial (LA) structure/function as assessed by three-dimensional echocardiography (3DE) in a large longitudinal bi-racial population study. Methods and results We conducted a prospective post hoc analysis of individuals enrolled at the Coronary Artery Risk Development in Young Adults, which is a multi-centre bi-racial cohort with 30 years of follow-up. Cumulative systolic and diastolic BP levels were defined by summing the product of average millimetres of mercury and the years between each two consecutive clinic visits over 30 years of follow-up. Multivariable linear regression analyses were used to assess the relationship between cumulative systolic and diastolic BP with 3DE LA structure and function, adjusting for demographics and traditional cardiovascular risk factors. A total of 1033 participants were included, mean age was 55.4 ± 3.5 years, 55.2% women, 43.9% blacks. Cumulative systolic BP had stronger correlations than cumulative diastolic BP. Higher cumulative systolic BP was independently associated with higher 3D LA volumes: maximum (β = 1.74, P = 0.004), pre-atrial contraction (β = 1.87, P < 0.001), minimum (β = 0.76, P = 0.04), total emptying (β = 0.98, P = 0.006), active emptying (β = 1.12, P < 0.001), and lower magnitude 3D LA early diastolic strain rate (β = 0.05, P = 0.02). Higher cumulative diastolic BP was independently associated with higher 3D LA active emptying volume (β = 0.66, P = 0.002), lower magnitude 3D LA early diastolic strain rate (β = 0.05, P = 0.004), and higher magnitude 3D LA late diastolic strain rate (β = -0.04, P = 0.05). Conclusion Higher cumulative BP from early adulthood throughout middle age was associated with adverse LA remodelling evaluated by 3D echocardiography.
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Affiliation(s)
- Henrique D Vasconcellos
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
- Department of Medicine, Federal University of Sao Francisco Valley, Av. Jose de Sa Manicoba, S/N, Centro, Petrolina, PE, Brazil
| | - Henrique T Moreira
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
- Division of Cardiology, Universidade of Sao Paulo, Ribeirao Preto, Av. Bandeirantes, 3.900 Monte Alegre, Ribeirão Preto, SP, Brazil
| | - Luisa Ciuffo
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Chike C Nwabuo
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Guilherme S Yared
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Bharath Ambale-Venkatesh
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Anderson C Armstrong
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Satoru Kishi
- Division of Diabetes, Memorial Hospital, 1 Izumicho Kanda, Chiyoda, Tokyo, Japan
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, 31 Center Drive, Bethesda, MD, USA
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, 675 N St Clair St STE 19-100, Chicago, IL, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, 675 N St Clair St STE 19-100, Chicago, IL, USA
| | - Laura A Colangelo
- Department of Preventive Medicine, Northwestern University, 675 N St Clair St STE 19-100, Chicago, IL, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Minneapolis, MN, USA
| | - Stephen Sidney
- Division of Research, Department of Pediatrics, Kaiser Permanente Center, 3600 Broadway, Oakland, CA, USA
| | - Samuel S Gidding
- Division of Pediatrics Cardiology, Nemours Cardiac Center, 1600 Rockland Road Wilmington, DE, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
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Parikh NI, Kapphahn K, Hedlin H, Olgin JE, Allison MA, Magnani JW, Ryckman KR, Waring ME, Perez MV, Howard BV. Effects of reproductive period duration and number of pregnancies on midlife ECG indices: a secondary analysis from the Women's Health Initiative Clinical Trial. BMJ Open 2018; 8:e019129. [PMID: 30121588 PMCID: PMC6104755 DOI: 10.1136/bmjopen-2017-019129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Pregnancy, menses and menopause are related to fluctuations in endogenous sex hormones in women, which cumulatively may alter cardiac electrical conduction. Therefore, we sought to study the association between number of pregnancies and reproductive period duration (RD, time from menarche to menopause) with ECG intervals in the Women's Health Initiative Clinical Trials. DESIGN Secondary analysis of multicentre clinical trial. SETTING USA. PRIMARY OUTCOME MEASURES ECGintervals: PR interval, P-wave duration, P-wave dispersion, QTc interval. PARTICIPANTS n=40 687 women (mean age=62 years) participating in the Women's Health Initiative Clinical Trials. 82.5% were white, 9.3% black, 4% Hispanic and 2.7% Asian. METHODS In primary analysis, we employed multivariable linear regression models relating number of pregnancies and RD with millisecond changes in intervals from enrolment ECG. We studied effect modification by hormone therapy use. RESULTS Among participants, 5+ live births versus 0 prior pregnancies was associated with a 1.32 ms increase in PR interval (95% CI 0.25 to 2.38), with a graded association with longer QTc interval (ms) (none (prior pregnancy, no live births)=0.66 (-0.56 to 1.88), 1=0.15 (-0.71 to 1.02), 2-4=0.25 (-0.43 to 0.94) and 5+ live births=1.15 (0.33 to 1.98), p=0.008). RD was associated with longer PR interval and maximum P-wave duration (but not P-wave dispersion) among never users of hormone therapy: (PR (ms) per additional RD year: 0.10 (0.04 to 0.16); higher P-wave duration (ms): 0.09 (0.06 to 0.12)). For every year increase in reproductive period, QTc decreased by 0.04 ms (-0.07 to -0.01). CONCLUSIONS An increasing number of live births is related to increased and RD to decreased ventricular repolarisation time. Both grand multiparity and longer RD are related to increased atrial conduction time. Reproductive factors that alter midlife cardiac electrical conduction system remodelling in women may modestly influence cardiovascular disease risk in later life. TRIAL REGISTRATION NUMBER NCT00000611; Post-results.
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Affiliation(s)
- Nisha I Parikh
- Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Kristopher Kapphahn
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Haley Hedlin
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jeffrey E Olgin
- Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Matthew A Allison
- Department of Family Medicine, University of California, San Diego, San Diego, California, USA
| | - Jared W Magnani
- Division of Cardiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kelli R Ryckman
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Molly E Waring
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Marco Valentin Perez
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, Maryland, USA
- Georgetown and Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia, USA
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Şerban RC, Scridon A. Data Linking Diabetes Mellitus and Atrial Fibrillation-How Strong Is the Evidence? From Epidemiology and Pathophysiology to Therapeutic Implications. Can J Cardiol 2018; 34:1492-1502. [PMID: 30404752 DOI: 10.1016/j.cjca.2018.08.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 01/01/2023] Open
Abstract
According to estimates, around 5% of the world population has hazel eyes. And there are about as many people with diabetes mellitus (DM). Red hair occurs naturally in up to 2% of the human population. And about as many people are estimated to have atrial fibrillation (AF). If a hazel eyed person with red hair does not surprise us, should a diabetic patient with AF? Accumulating epidemiologic data suggest, however, that the DM-AF association may be more than a simple coincidence. But, how strong is this evidence? Experimental studies bring evidence for a DM-induced atrial proarrhythmic remodelling. But how relevant are these data for the clinical setting? In this review, we aim to provide a critical analysis of the existing clinical and experimental, epidemiologic, and mechanistic data that bridge DM and AF, we emphasize a number of questions that remain to be answered, and we identify hotspots for future research. The therapeutic implications of the DM-AF coexistence are also discussed, with a focus on rhythm control and on conventional and DM-specific upstream therapies for AF management.
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Affiliation(s)
- Răzvan C Şerban
- Physiology Department, University of Medicine and Pharmacy of Târgu Mureş, Târgu Mureş, Romania; Laboratory of Cardiac Catheterization, Angiography and Electrophysiology, Emergency Institute for Cardiovascular Diseases and Transplantation, Târgu Mureş, Romania
| | - Alina Scridon
- Physiology Department, University of Medicine and Pharmacy of Târgu Mureş, Târgu Mureş, Romania.
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Oka T, Inoue K, Tanaka K, Ninomiya Y, Hirao Y, Tanaka N, Okada M, Inoue H, Nakamaru R, Koyama Y, Okamura A, Iwakura K, Sakata Y, Fujii K. Left Atrial Reverse Remodeling After Catheter Ablation of Nonparoxysmal Atrial Fibrillation in Patients With Heart Failure With Reduced Ejection Fraction. Am J Cardiol 2018; 122:89-96. [PMID: 29703439 DOI: 10.1016/j.amjcard.2018.03.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/27/2018] [Accepted: 03/05/2018] [Indexed: 11/29/2022]
Abstract
The efficacy of catheter ablation (CA) of nonparoxysmal atrial fibrillation (PAF) in patients with left ventricular systolic dysfunction is controversial. We investigated the outcomes of CA for non-PAF in patients with reduced left ventricular ejection fraction (LVEF) and the impact of early left atrial (LA) reverse remodeling on these outcomes. A total of 251 consecutive patients who underwent CA for non-PAF were divided into 2 groups (reduced: preoperative LVEF ≤55%, LVEF: 46.5 ± 8.7%, n = 63; normal: >55%, 65.8 ± 5.8%, n = 188). We analyzed the 4-year atrial fibrillation- or atrial tachycardia (AT)-free survival rate and assessed changes in LVEF, hemodynamics, and LA reverse remodeling at the end of a 90-day blanking period. We also evaluated LA reverse remodeling in patients with and without recurrence. The atrial fibrillation- or AT-free survival rates were similar (reduced vs normal 48% vs 42%, p = 0.32). The reduced group exhibited significant LVEF improvement (before vs after, 46.5 ± 8.7% vs 58.4 ± 11.5%, p<0.001), reduced mitral regurgitation, and spectral tissue Doppler-derived index, and had greater percent maximum left atrial volume reduction (reduced vs normal 25.3 ± 18.2% vs 19.3 ± 16.2%, p = 0.014). Percent maximum left atrial volume reduction was greater in patients without recurrence (with recurrence vs without recurrence 17.3 ± 16.7% vs 25.4 ± 16.1%, p<0.001). In conclusion, the efficacy of non-PAF CA in patients with reduced LVEF was comparable with that in patients with normal LVEF. Greater LA reverse remodeling in these patients suggests an association with a reduced recurrence rate.
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Affiliation(s)
- Takafumi Oka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan.
| | - Koji Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yuichi Ninomiya
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yuko Hirao
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Masato Okada
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Hiroyuki Inoue
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Ryo Nakamaru
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yasushi Koyama
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Atsunori Okamura
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Katsuomi Iwakura
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenshi Fujii
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
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Grieco D, Palamà Z, Borrelli A, De Ruvo E, Sciarra L, Scarà A, Goanta E, Calabrese V, Pozzilli P, Di Sciascio G, Calò L. Diabetes mellitus and atrial remodelling in patients with paroxysmal atrial fibrillation: Role of electroanatomical mapping and catheter ablation. Diab Vasc Dis Res 2018; 15:185-195. [PMID: 29338326 DOI: 10.1177/1479164117752492] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Complex fractionated atrial electrograms (CFAEs) are related to atrial fibrosis, but their ablation has not yet shown superiority. The aim of the study was to compare, in terms of clinical outcome, two strategies of paroxysmal atrial fibrillation (AF) ablation in patients with type 1 diabetes mellitus (DM): pulmonary vein isolation (PVI) vs. PVI + CFAEs. Compared to an historical population of patient with paroxysmal AF and without DM, a higher percentage of patients with DM showed more than 25% of atrial area interested by CFAEs (study population, 58% vs historical group, 15%; p < 0.05). In PVI group, recurrences rate was similar in patients with HbA1c ⩽ 7.5% vs HbA1c > 7.5% (30% vs 22%; p = not significant), but a greater AF burden was observed in patients with HbA1c > 7.5% (6 ± 2 vs 1 ± 2; p < 0.05). In hazard ratios analysis PVI+CFAEs seems more effective than PVI alone in patients with HbA1c > 7.5% (hazard ratio, 1.28; p < 0.05), more than 25 years from DM diagnosis (hazard ratio, 1.25; p < 0.05) and more than five AF episodes/year (hazard ratio, 1.2; p < 0.05). Type 1 DM patients had complex atrial 'substrate', as documented by wider CFAEs areas. Despite this, 1-year follow-up recurrence rate was similar between two ablation approaches (PVI 27% vs. PVI+CFAEs 21%; p = not significant). In our study, only specific subgroups, like patients with disglycaemic state (HbA1c > 7.5%), long diabetes mellitus history and high AF burden, benefit from PVI+ CFAEs approach.
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Affiliation(s)
| | | | | | | | - Luigi Sciarra
- 1 Cardiology Unit, Policlinico Casilino, Rome, Italy
| | - Antonio Scarà
- 1 Cardiology Unit, Policlinico Casilino, Rome, Italy
| | - Emilia Goanta
- 2 Institutul De Boli Cardiovasculare Timisoara, Timisoara, Romania
| | - Vito Calabrese
- 3 Cardiology Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Paolo Pozzilli
- 4 Endocrinology and Diabetes Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Leonardo Calò
- 1 Cardiology Unit, Policlinico Casilino, Rome, Italy
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Hannukainen JC, Lautamäki R, Pärkkä J, Strandberg M, Saunavaara V, Hurme S, Soinio M, Dadson P, Virtanen KA, Grönroos T, Forsback S, Salminen P, Iozzo P, Nuutila P. Reversibility of myocardial metabolism and remodelling in morbidly obese patients 6 months after bariatric surgery. Diabetes Obes Metab 2018; 20:963-973. [PMID: 29206339 PMCID: PMC5888194 DOI: 10.1111/dom.13183] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/15/2017] [Accepted: 11/30/2017] [Indexed: 01/14/2023]
Abstract
AIMS To study myocardial substrate uptake, structure and function, before and after bariatric surgery, to clarify the interaction between myocardial metabolism and cardiac remodelling in morbid obesity. METHODS We studied 46 obese patients (age 44 ± 10 years, body mass index [BMI] 42 ± 4 kg/m2 ), including 18 with type 2 diabetes (T2D) before and 6 months after bariatric surgery and 25 healthy age-matched control group subjects. Myocardial fasting free fatty acid uptake (MFAU) and insulin-stimulated myocardial glucose uptake (MGU) were measured using positron-emission tomography. Myocardial structure and function, and myocardial triglyceride content (MTGC) and intrathoracic fat were measured using magnetic resonance imaging and magnetic resonance spectroscopy. RESULTS The morbidly obese study participants, with or without T2D, had cardiac hypertrophy, impaired myocardial function and substrate metabolism compared with the control group. Surgery led to marked weight reduction and remission of T2D in most of the participants. Postoperatively, myocardial function and structure improved and myocardial substrate metabolism normalized. Intrathoracic fat, but not MTGC, was reduced. Before surgery, BMI and MFAU correlated with left ventricular hypertrophy, and BMI, age and intrathoracic fat mass were the main variables associated with cardiac function. The improvement in whole-body insulin sensitivity correlated positively with the increase in MGU and the decrease in MFAU. CONCLUSIONS In the present study, obesity and age, rather than myocardial substrate uptake, were the causes of cardiac remodelling in morbidly obese patients with or without T2D. Cardiac remodelling and impaired myocardial substrate metabolism are reversible after surgically induced weight loss and amelioration of T2D.
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Affiliation(s)
| | | | - Jussi Pärkkä
- Department of Clinical PhysiologyTurku University HospitalTurkuFinland
| | | | | | - Saija Hurme
- Department of BiostatisticsUniversity of TurkuTurkuFinland
| | - Minna Soinio
- Department of EndocrinologyTurku University HospitalTurkuFinland
| | | | | | - Tove Grönroos
- Turku PET CentreÅbo Akademi UniversityTurkuFinland
- MediCity Research LaboratoryUniversity of TurkuTurkuFinland
| | | | - Paulina Salminen
- Division of Digestive Surgery and Urology, Department of Digestive SurgeryTurku University HospitalTurkuFinland
| | - Patricia Iozzo
- Institute of Clinical Physiology, National Research CouncilPisaItaly
| | - Pirjo Nuutila
- Turku PET CentreUniversity of TurkuTurkuFinland
- Department of EndocrinologyTurku University HospitalTurkuFinland
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Hohendanner F, Messroghli D, Bode D, Blaschke F, Parwani A, Boldt L, Heinzel FR. Atrial remodelling in heart failure: recent developments and relevance for heart failure with preserved ejection fraction. ESC Heart Fail 2018; 5:211-221. [PMID: 29457877 PMCID: PMC5880666 DOI: 10.1002/ehf2.12260] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Felix Hohendanner
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Daniel Messroghli
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
- Department of Internal Medicine—CardiologyDeutsches Herzzentrum BerlinBerlinGermany
| | - David Bode
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Florian Blaschke
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Abdul Parwani
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Leif‐Hendrik Boldt
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Frank R. Heinzel
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
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Bukowska A, Hammwöhner M, Corradi D, Mahardhika W, Goette A. Atrial thrombogenesis in atrial fibrillation : Results from atrial fibrillation models and AF-patients. Herzschrittmacherther Elektrophysiol 2018; 29:76-83. [PMID: 29234866 DOI: 10.1007/s00399-017-0543-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/14/2017] [Indexed: 06/07/2023]
Abstract
Atrial fibrillation (AF) is the most common cause of thromboembolic complications. The risk of suffering a thromboembolic complication depends on the accompanying cardiac risk factors and the patient's age. For patients who have an increased risk, which is now classified using the CHA2DS2-VASc score, initiation of long-term oral anticoagulation is the first-line treatment. In AF, thrombi arise in the left atrial appendage. The present review will summarize the basic pathophysiology of thrombogenesis in AF and will provide the molecular basis of a process called prothrombotic endocardial remodeling. Despite oral anticoagulation being a central component of therapy, the present results can be used to support concomitant therapy with statins, angiotensin II blockers, etc. to inhibit atrial thromogenesis.
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Affiliation(s)
- Alicja Bukowska
- Working Group of Molecular Electrophysiology, Institute of Clinical Chemistry and Pathobiochemistry, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Matthias Hammwöhner
- Department of Cardiology and Intensive Care Medicine, St. Vincenz Hospital, Am Busdorf 2, 33098, Paderborn, Germany
| | - Domenico Corradi
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T.), Unit of Pathology, University of Parma, Parma, Italy
| | - Wisno Mahardhika
- Department of Cardiology and Intensive Care Medicine, St. Vincenz Hospital, Am Busdorf 2, 33098, Paderborn, Germany
| | - Andreas Goette
- Working Group of Molecular Electrophysiology, Institute of Clinical Chemistry and Pathobiochemistry, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany.
- Department of Cardiology and Intensive Care Medicine, St. Vincenz Hospital, Am Busdorf 2, 33098, Paderborn, Germany.
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Abstract
Increased macrophage accumulation occurs in the atria of patients with atrial fibrillation (AF). However, the phenotype and functions of the macrophages in AF remain unclear. We investigated the macrophage-atrial myocyte interaction in AF patients and found that the increased macrophages were mainly pro-inflammatory macrophages (iNOS+, Arg1−). Tachypacing of HL-1 atrial myocytes also led to pro-inflammatory macrophage polarization. In addition, lipopolysaccharide (LPS)-stimulated pro-inflammatory macrophages-induced atrial electrical remodeling, evidenced by increased AF incidence and decreased atrial effective refractory period and L-type calcium currents (ICa-L) in both canine and mouse AF models. Depletion of macrophages relieved LPS-induced atrial electrical remodeling, confirming the role of pro-inflammatory macrophages in the pathogenesis of AF. We also found that the effect of LPS-stimulated macrophages on atrial myocytes was mediated by secretion of interleukin 1 beta (IL-1β), which inhibited atrial myocyte quaking protein (QKI) expression. IL-1β knockout in macrophages restored the LPS-stimulated macrophage-induced inhibition of QKI and CACNA1C (α1C subunit of L-type calcium channel) in atrial myocytes. Meanwhile, QKI overexpression in atrial myocytes restored the LPS-stimulated macrophage-induced electrical remodeling through enhanced binding of QKI to CACNA1C mRNA, which upregulated the expression of CACNA1C as well as ICa-L. In contrast, QKI knockout inhibited CACNA1C expression. Finally, using transcription factor activation profiling plate array and chromatin immunoprecipitation, we revealed that special AT-rich sequence binding protein 1 activated QKI transcription. Taken together, our study uncovered the functional interaction between macrophages and atrial myocytes in AF. AF induced pro-inflammatory macrophage polarization while pro-inflammatory macrophages exacerbated atrial electrical remodeling by secreting IL-1β, further inhibiting QKI expression in atrial myocytes, which contributed to ICa-L downregulation. Our study demonstrates a novel molecular mechanism underlying the pathogenesis and progression of AF and suggests that QKI is a potential therapeutic target.
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Affiliation(s)
- Zewei Sun
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Dongchen Zhou
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Xudong Xie
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Shuai Wang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Zhen Wang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Wenting Zhao
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Hongfei Xu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Liangrong Zheng
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China.
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Bakkestrøm R, Andersen MJ, Ersbøll M, Bro-Jeppesen J, Gustafsson F, Køber L, Hassager C, Møller JE. Early changes in left atrial volume after acute myocardial infarction. Relation to invasive hemodynamics at rest and during exercise. Int J Cardiol 2016; 223:717-722. [PMID: 27573595 DOI: 10.1016/j.ijcard.2016.08.228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/12/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dilatation of left atrium (LA) reflects chronic LA pressure or volume overload that possesses considerable prognostic information. Little is known regarding the interaction between LA remodeling after acute myocardial infarction (MI) and left atrial pressure at rest and during exercise. The objective was to assess changes in LA volume early after MI in patients with diastolic dysfunction and the relation to invasive hemodynamics and natriuretic peptides. METHODS 62 patients with left ventricle ejection fraction (LVEF)≥45%, diastolic E/e'>8 and LA volume index >34ml/m2 within 48h of MI were enrolled. After 1 and 4months blood sampling, echocardiography and right heart catheterization were performed during exercise test. RESULTS LA remodeling was considered in patients with a change from mild (35-41ml/m2), to severe (>48ml/m2) dilatation after 4months (Found in 22 patients (35%)). Patients with LA remodeling were characterized by lower a' (1month 8.9±2.0 vs. 10.4±2.5cm/s, p=0.002; 4month 8.8±2.0 vs. 10.4±2.4cm/s, p=0.007) and higher MR-proANP (1month 162±64 vs. 120±44pg/l, p=0.005; 4months 175±48 vs. 129±56pg/l, p=0.002). With exercise, pulmonary artery pressure, right atrial pressure and pulmonary capillary wedge pressure increased markedly in all patients. There were however, no significant differences in filling pressure at rest or during exercise irrespective of whether LA remodeling occurred. CONCLUSION Contrary to our hypothesis early LA dilatation after MI was weakly associated with resting and exercise induced changes in LA pressure overload. The dilatation was however associated with lower e' and higher MR-proANP.
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Affiliation(s)
- Rine Bakkestrøm
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | - Mads J Andersen
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark
| | - Mads Ersbøll
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark
| | - John Bro-Jeppesen
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark
| | - Finn Gustafsson
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark
| | - Lars Køber
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark
| | - Christian Hassager
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark
| | - Jacob E Møller
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark
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Qiao Y, Wu L, Hou B, Sun W, Zheng L, Ding L, Chen G, Zhang S, Yao Y. Functional mitral regurgitation: predictor for atrial substrate remodeling and poor ablation outcome in paroxysmal atrial fibrillation. Medicine (Baltimore) 2016; 95:e4333. [PMID: 27472715 PMCID: PMC5265852 DOI: 10.1097/md.0000000000004333] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Functional mitral regurgitation (FMR) is not uncommon in atrial fibrillation (AF) patients. We sought to investigate the association between FMR and atrial substrate remodeling as well as the ablation outcome in paroxysmal AF (PAF) patients.We retrospectively analyzed a prospectively enrolled cohort of 132 patients (age 55.1 ± 9.6 years, 75.8% male) with symptomatic PAF who underwent initial ablation in our institute. Functional mitral regurgitation was defined as regurgitation jet area to left atrium (LA) area ratio ≥ 0.1 without any primary valvular disease. Voltage mapping of LA was performed under sinus rhythm. Low voltage zones (LVZs) were semi-quantitatively estimated and presented as low voltage index. Follow-up for AF recurrence ≥ 12 months was performed.In total, 40 patients (29.6%) were detected with FMR, who were older than the non-FMR patients (P = 0.007) and had larger LA diameters (P = 0.02). Left atrium LVZs were observed in 64.9% of patients with FMR versus 22.1% patients without FMR (P < 0.001). Functional mitral regurgitation independently predicted the presence of LVZs (OR 7.286; 95% CI 3.023-17.562; P < 0.001). During a mean follow-up of 22.9 ± 6.5 months, 38 patients (28.8%) experienced AF recurrence. The recurrence rate was 60.0% and 19.5% in FMR and non-FMR cohort, respectively (log rank P < 0.001). Multivariate analysis showed that FMR was an independent predictor for AF recurrence (HR 2.291; 95% CI 1.062-4.942; P = 0.03).Functional mitral regurgitation was strongly associated with atrial substrate remodeling. Furthermore, patients with FMR have substantial risk for AF recurrence post ablation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yan Yao
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Correspondence: Yan Yao, Fuwai Hospital and Cardiovascular Institute, 167 Beilishi Road, Xicheng, Beijing 100037, China (e-mail: )
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Clauss S, Wakili R, Hildebrand B, Kääb S, Hoster E, Klier I, Martens E, Hanley A, Hanssen H, Halle M, Nickel T. MicroRNAs as Biomarkers for Acute Atrial Remodeling in Marathon Runners (The miRathon Study--A Sub-Study of the Munich Marathon Study). PLoS One 2016; 11:e0148599. [PMID: 26859843 PMCID: PMC4747606 DOI: 10.1371/journal.pone.0148599] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/21/2016] [Indexed: 12/01/2022] Open
Abstract
Introduction Physical activity is beneficial for individual health, but endurance sport is associated with the development of arrhythmias like atrial fibrillation. The underlying mechanisms leading to this increased risk are still not fully understood. MicroRNAs are important mediators of proarrhythmogenic remodeling and have potential value as biomarkers in cardiovascular diseases. Therefore, the objective of our study was to determine the value of circulating microRNAs as potential biomarkers for atrial remodeling in marathon runners (miRathon study). Methods 30 marathon runners were recruited into our study and were divided into two age-matched groups depending on the training status: elite (ER, ≥55 km/week, n = 15) and non-elite runners (NER, ≤40 km/week, n = 15). All runners participated in a 10 week training program before the marathon. MiRNA plasma levels were measured at 4 time points: at baseline (V1), after a 10 week training period (V2), immediately after the marathon (V3) and 24h later (V4). Additionally, we obtained clinical data including serum chemistry and echocardiography at each time point. Results MiRNA plasma levels were similar in both groups over time with more pronounced changes in ER. After the marathon miR-30a plasma levels increased significantly in both groups. MiR-1 and miR-133a plasma levels also increased but showed significant changes in ER only. 24h after the marathon plasma levels returned to baseline. MiR-26a decreased significantly after the marathon in elite runners only and miR-29b showed a non-significant decrease over time in both groups. In ER miRNA plasma levels showed a significant correlation with LA diameter, in NER miRNA plasma levels did not correlate with echocardiographic parameters. Conclusion MiRNAs were differentially expressed in the plasma of marathon runners with more pronounced changes in ER. Plasma levels in ER correlate with left atrial diameter suggesting that circulating miRNAs could potentially serve as biomarkers of atrial remodeling in athletes.
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Affiliation(s)
- Sebastian Clauss
- Medizinische Klinik und Poliklinik 1, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, United States of America
- * E-mail:
| | - Reza Wakili
- Medizinische Klinik und Poliklinik 1, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
| | - Bianca Hildebrand
- Medizinische Klinik und Poliklinik 1, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
| | - Stefan Kääb
- Medizinische Klinik und Poliklinik 1, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
| | - Eva Hoster
- Institute for Medical Informatics Biometry and Epidemiology, Ludwig-Maximilians-UniversitätMünchen, Munich, Germany
| | - Ina Klier
- Medizinische Klinik und Poliklinik 1, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
| | - Eimo Martens
- Medizinische Klinik und Poliklinik 1, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
| | - Alan Hanley
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, United States of America
| | - Henner Hanssen
- Department of Prevention and Sports Medicine, TechnischeUniversitätMünchen, Klinikumrechts der Isar (MRI), Munich, Germany
- Sports Medicine, Institute of Exercise and Health Sciences, University Basel, Basel, Switzerland
| | - Martin Halle
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
- Department of Prevention and Sports Medicine, TechnischeUniversitätMünchen, Klinikumrechts der Isar (MRI), Munich, Germany
| | - Thomas Nickel
- Medizinische Klinik und Poliklinik 1, Campus Grosshadern, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
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Yucesir I, Sahin Yildiz B, Coskun O, Yakal S, Bayraktar B, Metin G, Altan M, Yildiz M. Assessment of P wave duration and P wave dispersion in high level football referees. J Sports Med Phys Fitness 2016; 56:120-124. [PMID: 25692858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND P wave dispersion and P wave maximal duration reflect the activation of atrial muscle and is influenced by the mass of the excited tissue. It may reflect atrial remodelling, most likely atrial fibrosis. The purpose of this study was to measure P wave duration and P wave dispersion in the high level football referees. METHODS We recruited 104 elite and national referees with a training history of many years. The control group was made of 32 healthy sedentary subjects. The difference between P maximum and P minimum durations was defined as P wave dispersion. Echocardiographic parameters such as left atrial diameter were assessed with a Vivid 3 cardiovascular ultrasound system [3S sector probe (1.5-3.6 MHz), GE]. RESULTS P wave maximum duration, P wave dispersion, left ventricle posterior wall thickness, inter-ventricular septum thickness and left atrial diameter were increased in the football referees as compared with healthy sedentary subjects. There were significant correlations of P wave dispersion with left atrial diameter and left ventricle posterior wall thickness CONCLUSIONS P wave maximum duration, P wave dispersion and left atrial diameter were increased in the football referees. Also, there was a significant correlation between P wave dispersion and left atrial diameter.
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Affiliation(s)
- Ilker Yucesir
- School of Physical Education and Sports Istanbul University, Istanbul, Turkey -
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Snezhitsky VA, Yatskevich ES, Doroshenko EM, Smirnov VY, Dolgoshey TS, Rubinsky AY. [HOMOCYSTEINE AS A PROGNOSTIC MARKER OF ATRIAL REMODELING AND CLINICAL PICTURE IN PATIENTS WITH PAROXYSMAL AND PERSISTENT FORMS OF ATRIAL FIBRILLATION]. Klin Med (Mosk) 2016; 94:16-22. [PMID: 27172716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of this work was to study prognostic significance of the relationship between the homocysteine level, structural/functional atrial remodeling, and clinical picture of paroxysmal and persistent forms of atrial fibrillation (AF). The study included 75 patients with AF concomitant with coronary heart disease and hypertensive disease without apparent structural changes in myocardium. Group 1 was comprised of 48 patients with paroxysmal AF, group 2 of 27 patients with persistent AF. 19 patients with coronary heart disease and hypertensive disease without AF served as controls. The structural and functional state of the heart was evaluated based on two-dimensional trans-thoracal echocardiography with the use of the formulas for calculating left ventricular characteristics. Blood homocysteine levels were measured The frequency of AF relapses was determined after an 1 year follow-up. The homocysteine level over 11.2 mcmol/l was related to left ventricle enlargement (over 40 mm), high frequency and relapse rate of AF. It is concluded that the relationship between homocysteine levels, left ventricle size, frequency and relapse rate of AF suggests the influence of homocysteine on atrial remodeling. A rise in the homocysteine level above 11 mcmol/l should be regarded as a prognostic factor of increased AF relapse rate.
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Lewkowicz J, Knapp M, Tankiewicz-Kwedlo A, Sawicki R, Kamińska M, Waszkiewicz E, Musiał WJ. MMP-9 in atrial remodeling in patients with atrial fibrillation. Ann Cardiol Angeiol (Paris) 2015; 64:285-291. [PMID: 25869465 DOI: 10.1016/j.ancard.2014.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/31/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common arrhythmia and is associated with significant morbidity and mortality. The impact of matrix metalloproteinases (MMPs) on structural atrial remodeling and sustainment of AF in patients with persistent and permanent AF is unresolved. OBJECTIVES The aim was to evaluate MMP-9 and its tissue inhibitor-1 (TIMP-1) as markers of atrial remodeling in patients with persistent AF (PAF) who underwent electrical cardioversion (ECV) and in patients with permanent AF (continuous AF, CAF). PATIENTS AND METHODS Plasma levels of MMP-9 and TIMP-1, clinical findings, and echocardiographic parameters were evaluated in 39 patients with AF and in 14 controls with sinus rhythm. RESULTS The concentrations of MMP-9 were significantly higher in patients with PAF and CAF compared to controls. There was a significant increase of MMP-9 after ECV in the persistent AF group. The values of TIMP-1 were not significantly different between the groups. In patients with AF, MMP-9 levels were positively related to posterior wall thickness of the LV (r=0.356, P=0.049) and body mass index (r=0.367, P=0.046). CONCLUSION Elevated levels of MMP-9 were related to the occurrence and maintenance of AF. This suggests that MMP-9 can be a marker of atrial remodeling in patients with AF. Regulation of the extracellular collagen matrix might be a potential therapeutic target in AF.
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Affiliation(s)
- J Lewkowicz
- Department of Cardiosurgery, Medical University of Białystok, ul. M. Skłodowskiej-Cure 24a, 15-276, Białystok, Poland.
| | - M Knapp
- Department of Cardiology, Medical University of Białystok, Białystok, Poland
| | - A Tankiewicz-Kwedlo
- Department of Monitored Pharmacotherapy, Medical University of Białystok, Białystok, Poland
| | - R Sawicki
- Department of Cardiology, Medical University of Białystok, Białystok, Poland
| | - M Kamińska
- Department of Cardiology, Medical University of Białystok, Białystok, Poland
| | - E Waszkiewicz
- Department of Cardiology, Medical University of Białystok, Białystok, Poland
| | - W J Musiał
- Department of Cardiology, Medical University of Białystok, Białystok, Poland
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Matsushita N, Hirose M. [Roles of ATP-sensitive K+ channels in the prevention of ischemia-induced cardiac tachyarrhythmia]. Nihon Yakurigaku Zasshi 2015; 146:5-9. [PMID: 26165335 DOI: 10.1254/fpj.146.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Liu X, Xiao J, Zhu H, Wei X, Platt C, Damilano F, Xiao C, Bezzerides V, Boström P, Che L, Zhang C, Spiegelman BM, Rosenzweig A. miR-222 is necessary for exercise-induced cardiac growth and protects against pathological cardiac remodeling. Cell Metab 2015; 21:584-95. [PMID: 25863248 PMCID: PMC4393846 DOI: 10.1016/j.cmet.2015.02.014] [Citation(s) in RCA: 266] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 01/17/2015] [Accepted: 02/13/2015] [Indexed: 01/26/2023]
Abstract
Exercise induces physiological cardiac growth and protects the heart against pathological remodeling. Recent work suggests exercise also enhances the heart's capacity for repair, which could be important for regenerative therapies. While microRNAs are important in certain cardiac pathologies, less is known about their functional roles in exercise-induced cardiac phenotypes. We profiled cardiac microRNA expression in two distinct models of exercise and found microRNA-222 (miR-222) was upregulated in both. Downstream miR-222 targets modulating cardiomyocyte phenotypes were identified, including HIPK1 and HMBOX1. Inhibition of miR-222 in vivo completely blocked cardiac and cardiomyocyte growth in response to exercise while reducing markers of cardiomyocyte proliferation. Importantly, mice with inducible cardiomyocyte miR-222 expression were resistant to adverse cardiac remodeling and dysfunction after ischemic injury. These studies implicate miR-222 as necessary for exercise-induced cardiomyocyte growth and proliferation in the adult mammalian heart and show that it is sufficient to protect the heart against adverse remodeling.
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Affiliation(s)
- Xiaojun Liu
- Cardiovascular Division of the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Junjie Xiao
- Regeneration Lab and Experimental Center of Life Sciences, School of Life Science, Shanghai University, Shanghai 200444, China
| | - Han Zhu
- Cardiovascular Division of the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Xin Wei
- Cardiovascular Division of the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Colin Platt
- Cardiovascular Division of the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Federico Damilano
- Cardiovascular Division of the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Chunyang Xiao
- Cardiovascular Division of the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Vassilios Bezzerides
- Cardiovascular Division of the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA; Cardiovascular Department of Boston Children's Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Pontus Boström
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Lin Che
- Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Chunxiang Zhang
- Rush Medical College, Rush University, Chicago, IL 60612, USA
| | - Bruce M Spiegelman
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
| | - Anthony Rosenzweig
- Cardiovascular Division of the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA; Massachusetts General Hospital Cardiovascular Division and Harvard Medical School, Boston, MA 02115, USA.
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Chen X, Chen X, Cheng J, Hong J, Zheng C, Zhao J, Li J, Lin J. [Role of cyclic adenosine monophosphate response element binding protein in ventricular pacing induced cardiac electrical remodeling in a canine model]. Zhonghua Xin Xue Guan Bing Za Zhi 2015; 43:334-340. [PMID: 26082366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This project is designed to explore the potential role of cyclic adenosine monophosphate (cAMP) response element binding protein (CREB) in cardiac electrical remodeling induced by pacing at different ventricular positions in dogs. METHODS An animal model by implanting the pacemakers in beagles was established. According to the different pacing positions, the animals were divided into 4 groups:conditional control group (n=6), left ventricle pacing group (n=6), right ventricle pacing group (n=6) and bi-ventricle pacing group (n=6). Cardiac and electrical remodeling were observed by echocardiography, electrocardiogram and plasma BNP. Myocardial pathology and protein expression of extracellular regulated protein kinases1/2 (ERK1/2), P38 mitogen activated protein kinases (P38 MAPK) and CREB were examined at 4 weeks post pacing. RESULTS Cardiac structure and plasma BNP level were similar among 4 groups (all P>0.05). Electrocardiogram derived Tp-Te interval was significantly prolonged post pacing (92±11, 91±10, and 79±13 ms vs. 60±12 ms), and the Tp-Te interval in bi-ventricle pacing group was shorter than in left or right ventricle pacing group (P < 0.05). Western blot results showed that the expression of p-ERK1/2 in left ventricular myocardium of left ventricle pacing group, right ventricular myocardium of right ventricle pacing group and bi-ventricular myocardium of bi-ventricle pacing group was 2.7±0.4, 2.4±0.2, 1.7±0.1 and 1.9±0.2, respectively, the expression of p-P38 MAPK was 1.9±0.3, 1.7±0.2, 0.8±0.1 and 1.1±0.1, respectively, and the expression of p-CREB was 2.1±0.2, 2.0±0.2, 2.7±0.4 and 2.6±0.3, respectively. The p-ERK1/2 and p-P38 MAPK expression of bi-ventricle pacing group was lower,but the p-CREB expression was higher compared to the other pacing groups (P < 0.05). CONCLUSIONS Ventricular pacing could induce electrical remodeling evidenced by prolonged Tp-Te interval and increased phosphorylation of ERK1/2 and p38 MAPK and reduced phosphorylation of CREB. Compared with single ventricle pacing, bi-ventricle pacing could attenuate electrical remodeling in this model.
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Affiliation(s)
- Xuesi Chen
- Department of Cardiology, Second Hospital Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Xingxing Chen
- Department of Cardiology, Second Hospital Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Junhua Cheng
- Department of Cardiology, Second Hospital Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Jun Hong
- Department of Cardiology, Second Hospital Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Cheng Zheng
- Department of Cardiology, Second Hospital Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Jinglin Zhao
- Department of Cardiology, Second Hospital Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Jin Li
- Department of Cardiology, Second Hospital Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Jiafeng Lin
- Department of Cardiology, Second Hospital Affiliated to Wenzhou Medical University, Wenzhou 325000, China;
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Singla DK, Singla RD, Abdelli LS, Glass C. Fibroblast growth factor-9 enhances M2 macrophage differentiation and attenuates adverse cardiac remodeling in the infarcted diabetic heart. PLoS One 2015; 10:e0120739. [PMID: 25768089 PMCID: PMC4359124 DOI: 10.1371/journal.pone.0120739] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 01/26/2015] [Indexed: 11/24/2022] Open
Abstract
Inflammation has been implicated as a perpetrator of diabetes and its associated complications. Monocytes, key mediators of inflammation, differentiate into pro-inflammatory M1 macrophages and anti-inflammatory M2 macrophages upon infiltration of damaged tissue. However, the inflammatory cell types, which propagate diabetes progression and consequential adverse disorders, remain unclear. The current study was undertaken to assess monocyte infiltration and the role of fibroblast growth factor-9 (FGF-9) on monocyte to macrophage differentiation and cardioprotection in the diabetic infarcted heart. Db/db diabetic mice were assigned to sham, myocardial infarction (MI), and MI+FGF-9 groups. MI was induced by permanent coronary artery ligation and animals were subjected to 2D transthoracic echocardiography two weeks post-surgery. Immunohistochemical and immunoassay results from heart samples collected suggest significantly increased infiltration of monocytes (Mean ± SEM; MI: 2.02% ± 0.23% vs. Sham 0.75% ± 0.07%; p<0.05) and associated pro-inflammatory cytokines (TNF-α, MCP-1, and IL-6), adverse cardiac remodeling (Mean ± SEM; MI: 33% ± 3.04% vs. Sham 2.2% ± 0.33%; p<0.05), and left ventricular dysfunction (Mean ± SEM; MI: 35.4% ± 1.25% vs. Sham 49.19% ± 1.07%; p<0.05) in the MI group. Importantly, treatment of diabetic infarcted myocardium with FGF-9 resulted in significantly decreased monocyte infiltration (Mean ± SEM; MI+FGF-9: 1.39% ± 0.1% vs. MI: 2.02% ± 0.23%; p<0.05), increased M2 macrophage differentiation (Mean ± SEM; MI+FGF-9: 4.82% ± 0.86% vs. MI: 0.85% ± 0.3%; p<0.05) and associated anti-inflammatory cytokines (IL-10 and IL-1RA), reduced adverse remodeling (Mean ± SEM; MI+FGF-9: 11.59% ± 1.2% vs. MI: 33% ± 3.04%; p<0.05), and improved cardiac function (Fractional shortening, Mean ± SEM; MI+FGF-9: 41.51% ± 1.68% vs. MI: 35.4% ± 1.25%; p<0.05). In conclusion, our data suggest FGF-9 possesses novel therapeutic potential in its ability to mediate monocyte to M2 differentiation and confer cardiac protection in the post-MI diabetic heart.
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Affiliation(s)
- Dinender K. Singla
- Biomolecular Science Center, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States of America
- * E-mail:
| | - Reetu D. Singla
- Biomolecular Science Center, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States of America
| | - Latifa S. Abdelli
- Biomolecular Science Center, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States of America
| | - Carley Glass
- Biomolecular Science Center, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States of America
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Sun YG, Wang XY, Chen X, Shen CX, Li YG. Hydrogen sulfide improves cardiomyocytes electrical remodeling post ischemia/reperfusion injury in rats. Int J Clin Exp Pathol 2015; 8:474-481. [PMID: 25755736 PMCID: PMC4348841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/24/2014] [Indexed: 06/04/2023]
Abstract
Hydrogen sulfide (H2S), produced by cystanthionine-γ-lysase (CSE) in the cardiovascular system, is an endogenous gaseous mediator exerting pronounced physiological effects as the third gasotransmitter in addition to nitric oxide (NO) and carbon monoxide (CO). Accumulating evidence indicated that H2S could mediate the cardioprotective effects in myocardial ischemia model. Ventricular arrhythmia is the most important risk factor for cardiac mortality and sudden death after acute myocardial infarction (AMI). The potential impact of H2S on cardiomyocytes electrical remodeling post ischemic insult is not fully explored now. Present study investigated the role of H2S on cardiomyocytes electrical remodeling in rats with ischemia/reperfusion injury. H2S concentration was reduced and arrhythmia score was increased in this model. CSE mRNA level was also upregulated in the ischemic myocardium. Exposure to exogenous NaHS reduced the action potential duration (APD), inhibited L-type Ca(2+) channels and activated K(ATP) channels in cardiomyocytes isolated from ischemic myocardium Exogenous H2S application improves electrical remodeling in cardiomyocytes isolated from ischemic myocardium. These results indicated that reduced H2S level might be linked to ischemia/reperfusion induced arrhythmias.
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Affiliation(s)
- Ying-Gang Sun
- Department of Cardiovascular Diseases, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200092, China
| | - Xin-Yan Wang
- Department of Anatomy and Physiology, Shanghai Institute of Health ScienceShanghai 201318, China
| | - Xiu Chen
- Department of Cardiovascular Diseases, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200092, China
| | - Cheng-Xing Shen
- Department of Cardiovascular Diseases, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200092, China
| | - Yi-Gang Li
- Department of Cardiovascular Diseases, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200092, China
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50
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Zhang Y, Dedkov EI, Lee B, Li Y, Pun K, Gerdes AM. Thyroid hormone replacement therapy attenuates atrial remodeling and reduces atrial fibrillation inducibility in a rat myocardial infarction-heart failure model. J Card Fail 2014; 20:1012-9. [PMID: 25305503 DOI: 10.1016/j.cardfail.2014.10.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/29/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Heart failure (HF) is associated with increased atrial fibrillation (AF) risk. Accumulating evidence suggests the presence of myocardial tissue hypothyroidism in HF, which may contribute to HF development. In a recent report we demonstrated that hypothyroidism, like hyperthyroidism, leads to increased AF inducibility. The present study was designed to investigate the effect of thyroid hormone (TH) replacement therapy on AF arrhythmogenesis in HF. METHODS AND RESULTS Myocardial infarction (MI) was produced in rats by means of coronary artery ligation. Rats with large MIs (>40%) were randomized into L-thyroxine (T4; n = 14) and placebo (n = 15) groups 2 weeks after MI. Rats received 3.3 mg T4 (in 60-day release form) or placebo pellets for 2 months. Compared with the placebo, T4 treatment improved cardiac function and decreased left ventricular internal diameters as well as left atrial diameter. T4 treatment attenuated atrial effective refractory period prolongation (45 ± 1.5 ms in placebo group vs 37 ± 1.6 ms in T4 group; P < .01) and reduced AF inducibility (AF/atrial flutter/tachycardia were inducible in 11/15 rats [73%] in the placebo- vs 4/14 rats [29%] in the T4-treated group; P < .05). Arrhythmia reduction was associated with decreased atrial fibrosis but was not associated with connexin 43 changes. CONCLUSIONS To our knowledge this is the first study demonstrating that TH replacement therapy in HF attenuates atrial remodeling and reduces AF inducibility after MI-HF. Clinical studies are needed to confirm such benefits in human patients.
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Affiliation(s)
- Youhua Zhang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York.
| | - Eduard I Dedkov
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Bianca Lee
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Ying Li
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Khusbu Pun
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - A Martin Gerdes
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
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